D.C. Mun. Regs. tit. 29, r. 29-10208
Each My Health GPS entity shall report to DHCF, quarterly, on the following two (2) measure sets:
My Health GPS Pay-for-Performance Measures | ||||
Measure Name | Measure Domain | National Quality Forum Number | Steward | Description |
1.Total Resource Use | Efficiency | 1598 | Health Partners | A risk adjusted measure of the frequency and intensity of services utilized by My Health GPS beneficiaries. Resource use includes all resources associated with treating My Health GPS beneficiaries including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services. |
2. Total Cost of Care | Efficiency | 1604 | Health Partners | A risk adjusted measure of My Health GPS entity's cost effectiveness at managing My Health GPS beneficiaries. Total cost of care includes all costs associated with treating My Health GPS beneficiaries including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services. |
3. Plan All-Cause Readmission | Utilization | 1768 | NCQA | For My Health GPS patients eighteen (18) years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within thirty (30) calendar days and the predicted probability of an acute readmission. Data is reported in the following categories: 1. Count of Index Hospital Stays (denominator) 2. Count of thirty (30)-Day Readmissions (numerator) 3. Average adjusted Probability of Readmission |
4. Potentially Preventable Hospitalization | Utilization | N/A | Agency for Healthcare Research and Quality | Percentage of inpatient admissions among My Health GPS beneficiaries for specific ambulatory care conditions that may have been prevented through appropriate outpatient care. |
5. Low-Acuity Non-Emergent Emergency Department Visits | Utilization | N/A | DHCF | Percentage of avoidable low-acuity non-emergent ED visits among My Health GPS beneficiaries. |
DHCF shall notify My Health GPS entities of any changes in the performance measures or measure specifications in § 10208.1(b) through transmittals issued to My Health GPS entities at least ninety (90) days before the reporting of the data required for the measure begins.
The baseline measurement period to determine the initial attainment and individualized improvement thresholds for measures outlined in § 10208.1(b) shall begin January 1, 2018 and end on December 31, 2018.
All subsequent attainment and individualized improvement thresholds shall be determined for measures outlined in § 10208.1(b) on an annual basis from January 1 through December 31, unless otherwise specified by DHCF.
Each My Health GPS entity shall utilize certified EHR technology to collect and report all data required for the quality measures described in §§ 10208.1(a) and 10208.1(b).
Each My Health GPS entity shall submit hybrid data as required by CMS and DHCF in accordance with protocols outlined in the My Health GPS provider manual.
Each My Health GPS entity shall report each sentinel event to DHCF within twenty-four (24) hours of occurrence in accordance with the procedure set forth in the My Health GPS provider manual.
Each My Health GPS entity may also be required to submit an annual program evaluation report to DHCF, which may include, but is not limited to, the following components:
D.C. Mun. Regs. tit. 29, r. 29-10208