Alcohol and Drug Misuse Screening (SBIRT)

• GOAL: Help members to visit their primary care provider each year.
  • At their well check, members will be screened for alcohol and drug use. If risky drinking or
    drug use is detected, a brief intervention or referral to treatment helps the member
    recover more quickly and avoid serious health problems. This metric can only be satisfied
    if the member receives the screening from their primary care provider during an office
    visit.

Cigarette Smoking Prevalence (SMO)

• GOAL: Help members to visit their primary care provider each year.
  • At their well check, members will be screened for currently smoking cigarettes or using
    other tobacco products and the provider will record it in the electronic health record.
    Tobacco use causes many diseases and quitting can have immediate and long-term health
    benefits. This metric can only be satisfied if the member’s cigarette use status is
    recorded at an office visit at their primary care provider.

Depression Screening with Follow-up (DEP)

• GOAL: Help screen members for depression, and if positive create a follow-up plan.
  • At their well check, members will be screened for depression and, if positive, their
    provider will refer them for follow-up. Depressive disorders are highly prevalent, chronic,
    and costly. They affect medical outcomes, economic productivity, and quality of life.
    Comprehensive screening in primary care may help providers identify undiagnosed
    depression and initiate appropriate treatment, improving these members’ depression and
    alleviating their suffering sooner or more thoroughly than if they had not been screened.
    This metric can only be satisfied if the member receives the screening from their primary care provider at an office visit.

Initiation and Engagement in Abuse or Dependence Treatment (IET)

• GOAL: Help members who have a new episode of alcohol and other drug (AOD) dependence to initiate in treatment services in a timely manner and maintain engagement in those services.
  • Improving coordination of care and communication between provider types for more
    timely and effective treatment for members. Timely access is critical and longer wait times
    increases attrition. This metric can only be satisfied if the member initiates treatment for
    AOD dependence/abuse within 13 days of the diagnosis, index episode start date (IESD), and engages in two or more additional treatment services within 34 days of the
    initiation visit.

Meaningful Language Access to Culturally Responsive Health Care Services (MLA)

• GOAL: Ensure members are receiving necessary interpreter services, translated materials, sign language, large print, or other adapted materials at every touch point with the health care system (health plan, primary care, behavioral health, dentist, specialists, etc.).
  • To achieve meaningful access to health care services for all members by providing quality
    communication, language access services, and culturally responsive care to all members,
    including members with limited English proficiency. This metric can only be satisfied if
    CHA can prove equitable language services are provided to members with a language
    need and pass the minimum requirements each year.

Adolescent Immunizations (AIS)

• GOAL: Help adolescents receive meningococcal, Tdap, and HPV immunizations before their thirteenth
  birthday.
  • Adolescents can receive immunizations through their primary care provider and the
    Klamath County Public Health Department. Vaccines are one of the safest, easiest, and
    most effective ways to protect adolescents from potentially serious diseases. Vaccines are
    also cost-effective tools that help to prevent the spread of serious diseases which can
    sometimes lead to widespread public health threats. This metric can only be satisfied if
    the member receives all immunizations prior to their thirteenth birthday.

Childhood Immunization Status (CIS)

• GOAL: Help children receive Dtap, IPV, MMR, HiB, HepB, and VZV immunizations before their second
  birthday.
  • Children can receive immunizations through their primary care provider and the Klamath
    County Public Health Department. Vaccines are one of the safest, easiest, and most
    effective ways to protect children from potentially serious diseases. Vaccines are also cost effective
    tools that help to prevent the spread of serious diseases which can sometimes
    lead to widespread public health threats. This metric can only be be satisfied if the member
    receives all immunizations on or before their second birthday.

Health Assessments for Children in DHS Custody (Foster Care) (DHS)

• GOAL: Help children in DHS custody receive applicable physical, mental, and oral health assessments
  timely.
  • Children who have been placed in foster care should have their health checked so that an
    appropriate care plan can be developed. Comprehensive health assessments are a
    requirement for the foster program because of their importance to improving the health
    and well-being of a child in a trying situation. This metric can only be satisfied if the
    member receives all applicable assessments within 60 days of entering foster care.

Preventative Dental Services (PDV)

• GOAL: Help children to visit their dentist each year.
  • Childhood tooth decay causes needless pain and infection and can affect a child’s
    academic performance and nutrition. Children from lower-income households have
    substantially higher rates of cavities and untreated decay, and more than twice the rate of
    rampant decay than children from higher-income households. This metric can be satisfied
    through preventative dental services by dentists, fluoride varnish by primary care
    providers, and screening and preventive services provided by Konnect Dental Kare in the school setting for children ages 1-14.

Well Child Visits (WCV)

• GOAL: Help children to visit their primary care provider each year.
  • Children who can easily access preventive health services are more likely to be healthy and
    able to reach milestones such as high school graduation, entry into the work force, higher
    education, or military service. This metric can only be satisfied if the member, age 3-6
    years old, sees their primary care provider annually for a well child visit.

Diabetes HbA1c Poor Control (A1c)

• GOAL: Help members with diabetes to achieve and maintain control of their HbA1c level through regular
  visits with their primary care provider each year and encourage member to get their HbA1c tested
  every three months for those not in control and every six months for those in glycemic control.
  • Controlling blood sugar levels is important to help people with diabetes stay healthy,
    manage their disease, and not develop other chronic diseases. This metric can only be
    satisfied if a member with diabetes has an HbA1c level below 9%.

ED Utilization for Members with Mental Illness (ED-MI)

• GOAL: Help members to visit their primary care provider at least annually and avoid unnecessary ED
  visits.
  • At their well check, members will have their preventative health needs addressed and
    learn about communication methods, such as a nurse advice line (refer to 2021 Incentive
    Metrics – Member Resources for phone numbers), to reduce the chance of an ED visit.
    Adults with mental illness have higher rates of preventable health conditions and use the
    ED at much higher rates than the general population. Improved coordination between
    physical and mental health care reduces unnecessary ED utilization and is a cornerstone of
    health system transformation. This metric can only be satisfied if members with mental
    illness limit their ED use.

Oral Evaluation for Adults with Diabetes (DOE)

• GOAL: Help members with diabetes to visit their dentist each year to have an oral evaluation.
  • Members with diabetes need to have an oral evaluation with a dentist each year because
    of the link between HbA1c levels and periodontitis. This metric can only be satisfied if the
    member receives one of three specific evaluations (comprehensive, periodic, or
    periodontal) from a dentist.

Prenatal and Postpartum Care (PPC)

• GOAL: Help members who are pregnant to visit their medical care provider through their entire
  pregnancy (prenatal) and after birth (postpartum).
  • Care during a pregnancy is widely considered the most productive and cost-effective ways
    to support the delivery of a healthy baby. This metric can only be satisfied if the member
    receives the necessary prenatal and postpartum care from their OB-GYN or primary care
    provider.