Determining Performance Benchmarks for a Medicaid Value-Based Payment Program (Presentation)
Publisher: Medicaid Innovation Accelerator Program Webinar
Jan 31, 2018
This presentation describes approaches that state Medicaid programs can consider when developing the benchmarks, or standards against which to judge performance, for value-based payment programs. It provides considerations for determining a benchmark when (1) a performance measure lacks a benchmark, or (2) an existing benchmark is not appropriate for the intended use or setting. For example, the National Committee for Quality Assurance develops Healthcare Effectiveness Data and Information Set (HEDIS®) measures; each of these measures and its corresponding benchmark targets a specific setting, such as health plan, physician, preferred provider organization, or other organizational setting. If a value-based payment program does not apply a HEDIS measures to the intended setting, the benchmark might also not apply. An existing benchmark can also require adjustment based on state-specific considerations, such as those shown in the box at right. With this purpose in mind, the brief begins with a short introduction, followed by a discussion of benchmarking methods and approaches to setting benchmarks.
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