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 MCOs and DMOs started in May 2018. These meetings are a follow-up of the one-on-one individual Quality Improvement meetings the Office of Value-Based Initiatives previously held regularly with each MCO. Staff from the Quality and Program Improvement Section initiate these calls.
The second initiative is the Quarterly Quality Provider Meetings, which involves provider associations such as the Texas Medical Association and Texas Hospital Association started in January 2016. Staff from the Office of Value-Based Initiatives 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 and program improvement in the context of promoting value-based care. The central paradigm of the dialogue is focused on measuring the value of healthcare provided to the state Medicaid and CHIP clients, within the healthcare delivery and payment reform led by HHSC.
The priority areas for these meetings are the following:
- Discussion of MCO, DMO and provider quality and program improvement activities.
- Discussion of MCO and DMO initiatives towards value-based payment (VBP) 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 VBP model.
- Discussion of MCOs' intervention strategies targeting special populations (clients with high costs and complex needs including those with substance use disorders, and those who need behavioral health services). These strategies could include VBP payment models as means to finance the interventions.
- Focused discussion on specific MCO/DMO quality measures. 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, DMOs and provider associations are a vital component of HHSC's comprehensive, data-driven quality improvement process. These meetings provide various HHSC units that have intersections with quality to engage more regularly with counterparts from MCOs, DMOs and provider associations in proactive discussions in these priority areas. Through this open dialogue, centered on publicly available data, HHSC will be able to more effectively assess progress, identify barriers and generally support MCOs, DMOs and providers in their efforts to improve quality and efficiency in the provision of health care services to Medicaid and CHIP clients.
Quarterly MCO/DMO Quality Meetings Resources
- April 16, 2021 Meeting (PDF)
- October 19, 2021 Meeting (PDF)
- February 16, 2022 Meeting (PDF)
- July 19, 2022 Meeting (PDF)
- November 2, 2022 Meeting (PDF)
Quarterly Quality Provider Meetings Resources
- September 20, 2021 Meeting (PDF)
- January 27, 2022 Meeting (PDF)
- May 16, 2022 Meeting (PDF)
- October 27, 2022 Meeting (PDF)
For more information email HHSC Quality.