RMHP Prime Quality Measures

MLR Quality Targets: Four quality measures are being used to measure performance in relation to the Adjusted MLR Target through the end of State Fiscal Year 15-16.  HEDIS measures used for the calculation will be based upon audited results produced for the 2016 NCQA and EQRO reporting cycle.

The following four measures have been established for year three of this initiative:

MeasureDescriptionTarget
Adult body mass index (BMI) assessment (HEDIS-ABA)Patients age 18-74 who were seen in the measurement year and had a BMI documented in the measurement year or year prior.91.28%
Antidepressant medication managementPatients over age 18 diagnosed with major depression who (a) receive effective acute phase treatment and (b) effective continuation phase treatment. (a) 59.35% (b) 42.29%
Comprehensive Diabetes Care (CDC): HbA1c Poor Control (>9.0%)Denominator: Patients 18-75 years as of December 31 of the measurement year with a diagnosis of Diabetes seen in measurement period. | Numerator: Patients 18-75 with Diabetes whose most recent A1c during the measurement year is > 9.0% or is missing a result or if an A1c was not done in the measurement year29.68%
Patient Activation Measure (PAM): process development and screening data collectionPAM is a commercial product which assesses an individual’s knowledge, skill, and confidence for managing one’s health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.At least eighty-five percent (85%) of the practices actively using the PAM tool will demonstrate use of the Coaching for Activation portion of the tool.