DE
"12.6 Outcomes
Objectives
The State,
in conjunction with the MCOs, will develop a system of incentives for reaching
outcome objectives in certain key areas to be defined by the State and
MCOs. These outcome objectives will include, at a minimum, childhood immunizations,
prenatal care, birth outcomes, pediatric asthma, and behavioral health
care. MCOs will be required to submit on a periodic basis objective numerical
data and/or narrative reports describing clinical and related information
on health services and outcomes of health care for the DHSSHP enrolled
populations.
The State, the EQRO, and the MCOs will also cooperate in the collection of data in order to provide accurate reports that can be used by DPH to create new millennial outcomes measures for the health and wellness of all Delawareans…" Delaware RFP, page II.73
"9.3 Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state's performance, taking into account suggested performance indicators as specified below or other indicators the state develops: (Section 2107(a)(4)(A),(B))
The State will use the first year of the SCHIP to develop base line information to monitor future years of the program. In addition, the State will expect the same utilization reporting for the SCHIP that we currently receive for the DSHP. We will also monitor the experience for the same age cohorts under the DSHP to look for possible outliers.
The State will require encounter data submission for the SCHIP. The State can also identify specific reporting categories and require the MCOs to report that information from their data base. The State will be able to report all of the HCFA required information identified in section 9.3.
9.3.4. 'X' The extent to which outcome measures show progress on one or more of the health problems identified by the state..." Delaware RFP, Appendix A (SCHIP), page A.37-A.38.
DC
"7. Operational
Indicators of Provider Performance and Encounter Data...
b.
Provider's description of its method for providing the District with aggregate
performance and outcome measures, as well as its description of policies
for transmission of data from network members in response to Sections C.9.2
and C.9.3 of Solicitation No. 7010-AA-NS-2-CR shall be incorporated into
this contract as a performance specification...
d. Provider shall submit additional aggregate outcome measures, as requested by the District. These aggregate outcome measure shall be developed by the District in collaboration with the Provider during the term of the contract. All such outcome measures shall be mutually agreed to by Provider and the District." District of Columbia Contract, pages 10-11.
IL
"EXHIBIT C
Summary of
Required Reports...
Name of Report
/ Frequency / DPA Prior Approval
QAP Annual
Report / Annually / no…
Preventive
Care Report / Quarterly / no…" Illinois HMO Contract, Exhibit C,
page 2.
IA
"OUTCOME STUDIES
1. Immunization
(required by ACIP schedule and influenza vaccinations for high-risk individuals)
Submit to the
Department on a quarterly basis following report form
CHILDHOOD IMMUNIZATION
RATES
Childhood immunization
rate for one year olds (summary of 12 months of data)
(children turning
one year old during the quarter preceding the reporting period quarter)...
Childhood immunization
rate for two year olds (summary of 12 months of data)
(children turning
two years old during the quarter preceding the reporting period quarter)...
2. Influenza
vaccination for high risk Enrollees...
Report the
percent of Enrollees in each high risk group receiving influenza immunization.
3. EPSDT/Well child visits (Submit to the Department on the quarterly basis following report form)…" Iowa Contract, pages 172, 174-175.
KY
"B. Reporting
Requirements
The
Contractor is responsible for complying with the reporting requirements
set forth in this Contract, including but not limited to the requirements
specified in Attachments II, III, and XIV of the RFA, and for assuring
the accuracy, completeness and timely submission of each report. The Contractor
shall provide such additional data and reports as may be reasonably requested
by the Department. The Department will furnish the Contractor with the
appropriate reporting formats, instructions, timetables for submission
and such technical assistance in filing reports and data as may be permitted
by the Department's available resources..." Kentucky Contract, page
26.
"O. Annual
Health Care Outcomes Report
1.
Reporting set Measures from Health Plan Employer Data Information Set (HEDIS).
2.
Required benchmarks from Health Promotion Program.
3.
Benchmarks from Iatrogenic Disorders Programs.
4.
Benchmarks from fiscally-incented list of health care outcomes."
Kentucky RFA, Attachment XIV, page 113.
MABH
"Section 5 of
Appendix A of the Contract is amended by inserting the following new Section
5.1.3.G...
Section 5.1.3.G.:
Performance Incentives, Penalties, and Initiatives: Provisions and Standards...
OUTCOMES MEASUREMENT
14. Review
of Provider Practice - The Contractor will survey providers on their use
of various outcomes measurement systems across providers of certain levels
of care, exclusive of individual providers and group practices. Such
review will examine these outcomes measurement practices with respect to
adults and children/adolescents for both mental health and substance abuse
services. The compliance target for this standard shall be the submission
of a report by May 1, 2000…" Massachusetts MH/SAP Contract, Amendment
6, page 8.
MO
"2.19
Operational Data Reporting:
To measure
the program's actual accomplishments in the areas of access to care, utilization,
medical outcomes, health status, and satisfaction, the health plan must
agree to provide the State with uniform utilization, quality assessment
and improvement, member satisfaction, and complaint data on a regular basis.
The health plan must agree to cooperate with the State in carrying out
data validation steps…" Missouri RFP, page 85.
"*MANAGED CARE
PLUS (MC+)*
Outcome Measures
Report Requirements" Missouri RFP, Enclosure Two.
"*QUALITY ASSESSMENT
AND IMPROVEMENT PLAN*
*Purpose*
To assure access
to quality service in the Managed Care Plus (MC+) Program, the Division
of Medical Services, Quality Assessment Unit will employ a variety of methods
and tools to measure outcomes of service that are provided through the
health plans and promote the process of ongoing quality improvement.
Quality of care will be measured and evaluated in a regular, ongoing manner
utilizing the following approach…" Missouri RFP, Attachment Eight.
SC
"Quality Assurance
and Utilization Review Requirements
All HMOs that
contract with the SCDHHS to provide Medicaid HMO Program Services must
have a Quality Assurance (QA) and Utilization Review (UR) process that
meets the following standards: …
3. Submit
information on quality of care studies undertaken which include care and
services to be monitored in certain priority areas as designated annually
by SCDHHS...
(a)
At a minimum, required quality of care studies will include indicators
for prenatal care, newborns, childhood immunizations and EPSDT examinations.
Quality Indicator Reports must be submitted to SCDHHS on a quarterly basis...
(b)
The HMO agrees to provide such outcome - based clinical reports as may
be requested by the SCDHHS.
(c)
Report the HEDIS Reporting Measures as outlined in Appendix M, Tab 1."
South Carolina Contract, Appendix G, pages 2-3.
VA
"L. QUALITY IMPROVEMENT (QI)...
1. Notification
to the Department of Sentinel Events
A.
The Contractor shall maintain a system for identifying and recording the
following sentinel events:
i.
Enrollee death
ii.
Emergency admission or readmission to the hospital for the same diagnosis
within a week of discharge
iii.
Return to the opening room during one inpatient stay
iv.
Post-surgical infection (including postpartum care)
B. At
a minimum, the following information must be documented on each sentinel
event:
i.
Enrollee name:
ii.
Enrollee's PCP's name: and
iii.
Circumstances of the sentinel event, including site of occurrence, reason
for occurrence, and remedies.
C. The Contractor shall provide the Department or its Agent with reports of sentinel events within ten (10) business days of request." Virginia Contract, pages 73-74.