What types of metrics or outcomes are you held to in your contracts with clinical partners and with insurance companies?

Mission Analytics Group
Kate_Russell
2 yrs ago
4replies

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.

- Mission Analytics Group
- Kate_Russell
- 2 yrs ago
- Reported - view
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!
- Community ConneXor
- Vickie_W_Harris
- 2 yrs ago
- Reported - view
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
- Aging & In Home Services of Northeast Indiana
- Chris_Forcucci
- 2 yrs ago
- Reported - view
# 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.
- SARCOA
- Dave_Crocker
- 2 yrs ago
- Reported - view
Timeliness of entries within the plan's clinical documentation system; Requirement to review medications during assessments; Decreased hospitalization rate post closure for participants;