Investor Presentaiton

'o offer a balanced perspective on health system performance, the Rhode Island Cost Trends Steering Committee recommended that OHIC begin reporting quality Cost Trends quality of care, in conjunction with efforts to aggressively control spending growth, is critical for a comprehensive picture of health system performance. Since 2017, OHIC has required commercial insurers to use core measures from OHIC's Aligned Measure Sets in any contract with a financial incentive tied to quality.1.2 In addition, Rhode Island Medicaid's Accountable Entities (AE) program requires measurement and reporting of AE quality performance using the Medicaid AE Common Measure Slate, which EOHHS voluntarily aligns with the OHIC Accountable Care Organization (ACO) Core Measure Set, to inform the distribution of any shared savings earned under total cost of care contracts. For these reasons, and because ACOs and AEs are assessed against the cost growth target, the Cost Trends Steering Committee recommended using OHIC's existing ACO Core Measure Set to monitor quality alongside spending growth.3 Starting with the 2021 performance year, OHIC is reporting commercial and Medicaid quality performance data for the Core Measures in OHIC's ACO Aligned Measure Set. This chapter presents these findings. 2021 ACO Core Measure Set The 2021 ACO Core Measure Set contained the following nine measures addressing three domains: chronic illness, behavioral health, and preventive care: ■ Breast Cancer Screening ■ Colorectal Cancer Screening ■Comprehensive Diabetes Care: Eye Exam ■ Comprehensive Diabetes Care: HbA1c Control (<8.0%) ■ Developmental Screening in the First Three Years of Life ■ Follow-Up After Hospitalization for Mental Illness (7-Day) ■ Weight Assessment and Counseling - BMI Percentile ■ Weight Assessment and Counseling - Counseling for Nutrition ■ Weight Assessment and Counseling - Counseling for Physical Activity OHIC obtains commercial performance on the ACO Core Measure Set measures directly from insurers as part of the cost growth target data collection.4 The Rhode Island EOHHS provides the data to calculate Medicaid performance on the ACO Core Measure Set measures.5 1 Rhode Island Code of Regulations, 230-RICR-20-30-4: Powers and Duties of the Office of the Health Insurance Commissioner, https://ohic.ri.gov/sites/g/files/xkgbur736/files/2022-03/230-ricr-20-30-4-final-sos.pdf. 2 3 For OHIC's guidance for insurers related to the implementation of its Aligned Measure Sets required under 230-RICR-20-30-4.10(D)(5), see: Office of the Health Insurance Commissioner, Updated Guidance on Use of Aligned Measure Set, October 11, 2022, https://ohic.ri.gov/sites/g/files/xkgbur736/files/2022-10/Aligned%20Measure%20Set%20Interpretive%20Guidance%202022 % 2010-11.pdf. For details on the data collection and analysis methodology, see: OHIC, Rhode Island Quality Reporting Implementation Manual, September 21, 2022, https://ohic.ri.gov/sites/g/files/xkgbur736/files/2022-09/RI%20Quality%20Implementation%20Manual_CY2021%20v1.0.pdf. 4 For more information on commercial ACO Core Measure Set data reporting requirements, see: Office of the Health Insurance Commissioner, Rhode Island Quality Reporting Implementation Manual, September 1, 2022, https://ohic.ri.gov/sites/g/files/xkgbur736/files/2022-09/RI%20Quality%20Implementation%20Manual_CY2021%20v1.0.pdf. 5 For more information on the AE Common Measure Slate data reporting requirements, see: Rhode Island Executive Office of Health and Human Services, Rhode Island Accountable Entity Program: Total Cost of Care Quality and Outcome Measures and Associated Incentive Methodologies for Comprehensive Accountable Entities: Implementation Manual, September 1, 2022, https://eohhs.ri.gov/media/36616/download?language=en. Annual Report: Health Care Spending and Quality in Rhode Island 21

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