Investor Presentaiton
Statewide Commercial Performance on the ACO
Core Measure Set
Rhode Island scored above the national 75th percentile for the commercial market
on all the measures, and exceeded the national 90th percentile on all but one of the
measures, Comprehensive Diabetes Care: HbA1c Control (see Table 4.1).
Table 4.1: Statewide Commercial Performance on ACO Core Measure Set
Measure
75TH PCTL
National Benchmarks
90TH PCTL
Statewide Performance
ABOVE 75TH
ABOVE 90TH
PCTL?
PCTL?
Breast Cancer Screening
Colorectal Cancer Screening
Comprehensive Diabetes Care: Eye Exam
73%
75%
Yes
Yes
84%
84%
66%
70%
Yes
Yes
79%
79%
54%
60%
Yes
Yes
68%
68%
Comprehensive Diabetes Care: HbA1c Control (<8.0%)
60%
64%
Yes
No
62%
62%
Developmental Screening in the First Three Years of Life
57%
65%
Yes
Yes
85%
85%
Follow-Up After Hospitalization for Mental Illness (7-Day)
53%
59%
Yes
Yes
69%
69%
Weight Assessment and Counseling - BMI Percentile
77%
83%
Yes
Yes
92%
92%
Weight Assessment and Counseling - Counseling for Nutrition
72%
78%
Yes
Yes
90%
90%
Weight Assessment and Counseling - Counseling for Physical Activity
69%
75%
Yes
Yes
89%
89%
Source: OHIC analysis of quality performance data submitted by commercial insurers in Rhode Island. Statewide commercial performance is based on a weighted average of
insurer performance using membership from the insurers' cost growth target data submissions, rather than performance for the full population, because multiple insurers
submitted population samples.
What Are OHIC's Aligned Measure Sets?
Insurers often provide financial incentives to providers for
meeting targets and/or demonstrating improvement on a
set of quality measures as a way of encouraging high-quality
health care. However, requirements for providers to report
their data to multiple insurers who each use a distinct set
of measures creates significant provider administrative
burden. It also risks diluting the impact of payer incentives by
spreading provider attention over a large number of measures.
To mitigate these adverse effects, Rhode Island stakeholders
undertook a collaborative effort in 2015 to identify a common
set of quality measures for use in contracts between insurers
and providers.
The Rhode Island State Innovation Model Test Grant supported
the initial measure alignment process by convening a
work group comprising stakeholders representing insurers,
providers, and consumers to develop the measure sets. OHIC
now convenes the OHIC Measure Alignment Work Group
annually to review and update the Aligned Measure Sets as
necessary. OHIC currently maintains aligned measure sets
for use in primary care, ACO, acute care hospital, behavioral
health hospital, outpatient behavioral health, and maternity
care contracts. Each of the measure sets include Core Measures
that insurers must use in applicable provider contracts; Menu
Measures that are for optional use; and Developmental
Measures that need further refinement and/or testing before
measure set adoption.
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