SIM Core Comments Measure Dashboard Current Payers? Applicable Applicable BHH? Applicable ACs? Applicable Possible? Interventions Impactful (H,M,L) dashboard Data Availability Measure beyond to to to to of All HH? Developmental N Y Y Y Y L/M Screenings Well Child N Y Partial Y Y L/M Visits Children 7-11 N Y Partial Y Some H/M IHOC focus already Access to PC All-cause Y Y Y Y Y H Overall negative trend, need Readmits additional trend information; but is opportunity for savings high enough; this is primarily a hospital measure Diabetic Care Current patients Y Y Y Y Y H Diabetic care for MaineCare (HbA1c) 18-75 with members is lower than for diabetes who have commercial, good opportunity had an HbA1c test across all payers in the last 12 mos Follow up after Y Y Y Y Some M Impactful interventions Hosp for available depending on data Mental Illness availability Non-Emergent Y Y Y Y Y H Good trend in this measure ED use already;should consider dev of categories, bifurcate ed use into physical & behavioral categories Fragmented The percentage of Y Y Y Y Y H If data/results different by Care members with a payers, are totally different fragmented care approaches needed? Care index of greater Coordinators look at than .75. A score fragmented care results by of 1 is complete member/practice? fragmentation, a
SIM Core Measure Current Dashboard Measure Applicable to All Payers? Applicable to HH? Applicable to BHH? Applicable to ACs? Impactful Interventions Possible? Availability of Data beyond dashboard (H,M,L) Comments Developmental Screenings N Y Y Y Y L/M Well Child Visits N Y Partial Y Y L/M Children 7-11 Access to PC N Y Partial Y Some H/M IHOC focus already All-cause Readmits Y Y Y Y Y H Overall negative trend, need additional trend information; but is opportunity for savings high enough; this is primarily a hospital measure Diabetic Care (HbA1c) Current patients 18-75 with diabetes who have had an HbA1c test in the last 12 mos Y Y Y Y Y H Diabetic care for MaineCare members is lower than for commercial, good opportunity across all payers Follow up after Hosp for Mental Illness Y Y Y Y Some M Impactful interventions available depending on data availability Non-Emergent ED use Y Y Y Y Y H Good trend in this measure already;should consider dev of categories, bifurcate ed use into physical & behavioral categories Fragmented Care The percentage of members with a fragmented care index of greater than .75. A score of 1 is complete fragmentation, a Y Y Y Y Y H If data/results different by payers, are totally different approaches needed? Care Coordinators look at fragmented care results by member/practice?
SIM%20Year%203%20Focus%20Area%20Decision%20Gridv3.docx