HHSC has launched two initiatives to hold quarterly calls with managed care organizations and providers respectively in Texas. The first initiative is the Quarterly MCO Quality Meetings which involves the MCOs and DMOs started in May 2018. These meetings are a follow-up of the one-on-one individual Quality Improvement meetings the Value-based Initiative office had with each MCO. Staff from the Quality and Program Improvement Section initiate these calls. Participation from HHSC also includes staff from Quality Assurance, Healthcare Transformation Waiver and Health Plan Management, with representation from the state's External Quality Review Organization.
The second initiative is the Quarterly Quality Provider Meetings with providers which started in January 2016. Staff from the Value-Based Initiatives office in the Quality and Program Improvement Section initiate these calls. Participation from HHSC may also include staff from Quality Assurance and the Healthcare Transformation Waiver.
The purpose of both initiatives is to maintain an interactive dialogue on priority areas related to quality improvement and efficiency in the context of value-based payment. The central paradigm of the dialogue is focused on measuring the value of healthcare provided to the state Medicaid and CHIP beneficiaries, within the healthcare delivery and payment reform led by HHSC.
The priority areas for these calls are the following:
- Discussion of MCOs and DMOs overall initiatives towards value-based payment contracts with providers (moving away from strict volume based reimbursement models toward payment models that link greater amounts of provider payment to value).
- Discussion of MCOs and DMOs efforts towards identification of high value Delivery System Reform Incentive Payment (DSRIP) projects and the steps the MCOs take towards integration of these projects into an MCO value-based payment model.
- Discussion of MCO's intervention strategies targeting special populations (beneficiaries with high costs and complex needs including super utilizers, those with substance use disorders, and those who need behavioral health services). These strategies could include value-based payment models as means to finance the interventions.
- Focused discussion on a specific MCO/DMO quality measure. The measures of interest are either proposed by the MCOs and DMOs or are selected by the Value-based Initiatives office. HHSC may provide analyses of the quality measure(s) to be discussed based on the following criteria:
- Data is publicly available on HHSC's Data and Reports quality webpage.
- Measure has high frequency or high cost.
- There is a significant trend from year to year.
These interactions with MCOs and DMOs are a vital component of HHSC's comprehensive and data driven quality improvement process. It is an opportunity for various HHSC units that have intersections with quality, to engage more regularly counterparts from individual MCOs in proactive discussions in these priority areas. Through this open dialogue, centered on publicly available data, HHSC will be able to more effectively assess each MCO's progress, identify barriers and generally support MCOs in their efforts to improve quality.
Quarterly MCO/DMO Quality Meetings Resources
For more information email HHSC Quality.