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2021 CCO Incentive Metrics

Oregon Measurement Strategy measures quality of and access to care for Oregon Health Plan individuals enrolled in CCOs.

These measure help Cascade Health Alliance show how well we are improving care, making quality care accessible, eliminating health disparities, and curbing the rising cost of health care.

Learn more about this process at: CCO Metrics Overview

For 2021, the quality incentive measures include:

Metrics Targeted to All Ages:

Alcohol and Drug Misuse: Screening, Brief Intervention and Referral for Treatment (SBIRT)

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

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

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

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

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.

Metrics Targeted to Pediatrics:

Adolescent Immunizations

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 Immunizations Status

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

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)

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)

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.

Metrics Targeted to Adults

Diabetes HbA1c Poor Control

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 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

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

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.