What types of metrics or outcomes are you held to in your contracts with clinical partners and with insurance companies?
AJ Diamontopoulos posed this question during the 2/22 Network Development meeting. Let us know if you have metrics from your contracts you would be willing to share.
4 replies
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Here are a few example metrics Ester Sefilyan from Partners in Care shared:
It does vary based on type of payor and type of service but here are some examples (this is not an all-inclusive list):
- Metrics/Outcomes
- # of referrals
- # of served
- # that did not get served and why
- Pre-established service level standards
- Timeliness around specific tasks (i.e acknowledgment of referral, outreach 1, etc.)
- Satisfaction with services
- Readmission %’s (self-reported from our end but we rely on the payor to provide us with actual claims data)
- SDOH findings (if assessment is involved)
Thanks Ester!
- Metrics/Outcomes
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Great question! Related to this question, we reviewed a podcast on the NEW CMS SOCIAL CARE QUALITY MEASURES to help frame our thinking. Found it extremely useful. Also found the repeated messaging throughout the podcast that this is a rapidly evolving area so "what is today may not be tomorrow". https://sirenetwork.ucsf.edu/tools-resources/resources/exploring-new-national-social-care-quality-measures-how-do-we-define-and
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# Referrals received, number of contact information that was not correct, number referrals reached who agreed to participate, reasons for declining, # of SDOH assessments completed, # and type of SDOH Gaps, # of identified gaps closed, # of referrals that need extended support to close all gaps, etc.
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Timeliness of entries within the plan's clinical documentation system; Requirement to review medications during assessments; Decreased hospitalization rate post closure for participants;
Content aside
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