Adult/child/ Reporting Quality Intermediate Actions Domain Measure Data source both Frequency Monitoring Achievement in goals & B OC Annual % of members reporting positive progress in Member survey Annual activities identified by EOC identified goals & activities member Skills development B QOC Annual % of members reporting learned coping skills Member survey Annual EOC that work Goal V: Reduce avoidable utilization of emergency department, inpatient and residential services (Right time, right place, right service) Adult/child/ Reporting Data Source Quality Intermediate Actions Domain Measure both Frequency Monitoring Prevention Quality A OC Annual MCO Annual Rate of inpatient hospital admissions for HH Indicator (PQI) 92: $ Members 18 years or more for ambulatory Chronic Condition SU care sensitive chronic conditions per 100,000 Composite [PQ192]: enrollee months (includes adult hospital CMS criterion admissions for diabetes with short-term (AHRQ) complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, or angina without a cardiac procedure) Plan All Cause A $ Annual MCO Annual % of acute inpatient stays during the Readmission Rate [PCR] SU measurement year for HH Members age 18 CMS criterion and older that were followed by an unplanned acute readmission for any diagnosis within 30 days.
Intermediate Actions Adult/child/ both Domain Reporting Frequency Measure Data source Quality Monitoring Achievement in goals & activities identified by member B OC EOC Annual % of members reporting positive progress in identified goals & activities Member survey Annual Skills development B QOC EOC Annual % of members reporting learned coping skills that work Member survey Annual Goal V: Reduce avoidable utilization of emergency department, inpatient and residential services (Right time, right place, right service) Intermediate Actions Adult/child/ both Domain Reporting Frequency Measure Data Source Quality Monitoring Prevention Quality Indicator (PQI) 92: Chronic Condition Composite [PQ192]: CMS criterion (AHRQ) A OC $ SU Annual Rate of inpatient hospital admissions for HH Members 18 years or more for ambulatory care sensitive chronic conditions per 100,000 enrollee months (includes adult hospital admissions for diabetes with short-term complications, diabetes with long-term complications, uncontrolled diabetes without complications, diabetes with lower-extremity amputation, chronic obstructive pulmonary disease, asthma, hypertension, heart failure, or angina without a cardiac procedure) MCO Annual Plan All Cause Readmission Rate [PCR] CMS criterion A $ SU Annual % of acute inpatient stays during the measurement year for HH Members age 18 and older that were followed by an unplanned acute readmission for any diagnosis within 30 days. MCO Annual
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