Performance Withhold Program
DMAS tracks MCO performance on several behavioral health related performance measures as part of the Performance Withhold Program (PWP) under both the Medallion and Commonwealth Coordinated Care Plus (CCC+) managed care programs. Under the PWP, managed care organizations (MCOs) are held financially accountable for attainment and improvement targets on a range of measures relevant to the populations they cover. Measures include:
- Follow-up care after an Emergency Department (ED) visit pertaining to mental illness (7-day and 30-day follow-up)
- Both the Medallion 4.0 and CCC+ PWPs include this measure. All MCOs under both programs perform above the NCQA Quality Compass® national Medicaid HMO 50th percentile on both 7- and 30-day follow-up.
- Follow-up care after an ED visit for alcohol and other drug (AOD) abuse or dependence (7-day and 30-day follow-up)
- The CCC+ PWP includes this measure and offers an area for improvement as half of CCC+ MCOs fall below the national Medicaid HMO 50th percentile on both 7- and 30-day follow-up.
- Initiation and engagement of alcohol and other drug abuse (AOD) or dependence treatment (Initiation of AOD and Engagement of AOD)
- The CCC+ PWP includes this measure and while all MCOs are above the national Medicaid HMO 50th percentile for initiation of AOD, only one MCO reaches this mark for the engagement of AOD sub-measure.
Accountability for these measures reinforces the expectation that members with significant behavioral health or addiction needs receive facilitated access to lower acuity settings and services to help them manage their conditions outside of high-acuity, emergency settings of care, such as the ED. Additional detail on the PWP methodologies for both CCC+ and Medallion 4.0 can be found on the DMAS website.
DMAS tracks and makes public detailed, MCO-specific performance rates for each of the PWP measures by program, as well as other measures not included in the PWP. This more detailed data can be found in the External Quality Review Technical Reports for CCC+ and Medallion 4.0.