ED use Encounter payment Total program; Trending over Annual data populations of time special interest; demographic characteristics; domains of service; care coordination level All cause Similar MCO facilities MCO; facility type; Trending over Reported by readmissions to 1768 readmission procedure code time MCOs report/NCQA quarterly; evaluator may CMS Core Quality summarize to Measure for Adults present annually Inpatient mental Encounter payment Total program; Trending over Annual health/substance use data populations of time services special interest; demographic characteristics; domains of service; care coordination level B. Has the Members Receiving Rewards in Each Category, as a Percentage of those with Eligible Conditions: member rewards Asthma controller MMIS and encounter Populations of Comparison to Annual program medication data; MCO member special interest; baseline; encouraged compliance (children) rewards report demographic trending over individuals to characteristics time better manage Diabetes - annual MMIS and encounter Populations of Comparison to Annual their care? recommended tests data; MCO member special interest; baseline; (A1C, LDL, eye rewards report demographic trending over exam, nephropathy characteristics time
ED use Encounter payment data Total program; populations of special interest; demographic characteristics; domains of service; care coordination level Trending over time Annual All cause readmissions Similar to 1768 MCO facilities readmission report/NCQA CMS Core Quality Measure for Adults MCO; facility type; procedure code Trending over time Reported by MCOs quarterly; evaluator may summarize to present annually Inpatient mental health/substance use services Encounter payment data Total program; populations of special interest; demographic characteristics; domains of service; care coordination level Trending over time Annual B. Has the member rewards program encouraged individuals to better manage their care? Members Receiving Rewards in Each Category, as a Percentage of those with Eligible Conditions: Asthma controller medication compliance (children) MMIS and encounter data; MCO member rewards report Populations of special interest; demographic characteristics Comparison to baseline; trending over time Annual Diabetes - annual recommended tests (A1C, LDL, eye exam, nephropathy MMIS and encounter data; MCO member rewards report Populations of special interest; demographic characteristics Comparison to baseline; trending over time Annual