Investor Presentaiton
Medicaid Insurers' Performance on the ACO Core Measure Set
Medicaid insurers' performance on the ACO Core Measure Set was better for the
chronic illness and behavioral health measures than for the preventative care
measures. The two Medicaid insurers (NHPRI and UHCCP) were both above the
national 75th percentile for Breast Cancer Screening, Comprehensive Diabetes Care:
Eye Exam, Follow-Up After Hospitalization for Mental Illness and Developmental
Screening in the First Three Years of Life. The insurers were above the 90th percentile
for only one measure - Developmental Screening in the First Three Years of Life.
Table C.2: Medicaid Insurers' Performance on ACO Core Measure Set
Measure
Breast Cancer Screening
Colorectal Cancer Screening
National Benchmarks
Above 75th Pctl?
Above 90th Pctl?
75TH PCTL
90TH PCTL
NHPRI
UHCCP
NHPRI
UHCCP
57%
61%
Yes
Yes
No
No
61%
58%
61%
58%
NA
NA
NA
NA
ΝΑ
NA
Comprehensive Diabetes Care: Eye Exam
57%
64%
Yes
Yes
No
No
63%
61%
63%
61%
Comprehensive Diabetes Care: HbA1c Control
(<8.0%)
54%
58%
Yes
No
No
No
55%
53%
55%
53%
Follow-Up After Hospitalization for Mental
Illness (7Day)4
46%
55%
Yes
Yes
No
No
54%
54%
54%
54%
Developmental Screening in the First Three
57%
65%
Yes
Yes
Yes
Yes
Years of Life5,6
80%
79%
80%
79%
Weight Assessment and Counseling - BMI
84%
86%
No
Yes
No
No
percentile
82%
85%
82%
85%
Weight Assessment and Counseling -
81%
84%
No
No
No
No
Counseling for Nutrition
75%
79%
75%
79%
Weight Assessment and Counseling -
78%
81%
No
No
No
No
Counseling for Physical Activity
73%
78%
73%
78%
Source: OHIC analysis of quality performance data of Rhode Island Medicaid managed care organizations obtained from the Rhode Island EOHHS.
Note: NA = Not Applicable. Insurer did not submit performance on this measure. EOHHS does not collect quality data from THPP due to its small population size.
4 BCBSRI did not include Follow-Up After Hospitalization for Mental Illness in its 2021 PQIP Program, thus no data were reported for 2021.
5 THPP was unable to report a MY 2021 rate for Developmental Screening in the First Three Years of Life. THPP is working with a vendor and will report this measure for MY 2022.
6 UHCCP indicated to OHIC that they could not report Developmental Screening in the First Three Years of Life at the plan level because it is not a HEDIS measure.
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