MHC Performance Management System Initial Performance Metrics. Page 1

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1 A. Outcome Measure: Number of ambulatory care sensitive condition hospital admissions per 100,000 by children under the age of 18 ACCESS Health Services Cost Review Maryland Health Care 90 days Reported and Commission (HSCRC) Inpatient Commission (MHCC) Collected Discharge Data quarterly B. Outcome Measure: Number of ambulatory care sensitive condition hospital admissions per 100,000 by adults 18 years of age and older C. Outcome Measure: Uncompensated hospital care costs Health Services Cost Review Commission (HSCRC) Inpatient Discharge Data Maryland Health Care Commission (MHCC) HSCRC Annual Cost Reports HSCRC 11 to 12 lag 90 days Reported and Collected quarterly Collected and reported annually Statewide, age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population under age 75 years. This measure can be used to indicate access to appropriate primary health care. It can be tracked over time to indicate reduced barriers to access related to coverage gains. This measure On the other hand, it could also signal provider capacity issues resulting from an increase in insured individuals seeking primary care services. See above description Percentage difference between billings at established rates and the amount collected from charity patients and patients who pay nothing or less than their total bill (composed of charity care and bad debt). This aggregate measure of bad debt and charity care can be used to measure the size of demand for safety net services. While initial trends in charity care will go down with coverage gains, long term monitoring of charity care can confirm continued coverage levels or signal coverage losses or possible issues with affordability of cost sharing. 1 MHC Measure: Number of individuals enrolled in Maryland Health Connection (MHC) on first day of 2 MHC Measure: Number of MAGI Medicaid enrollees through MHC on first day of 3 MHC Measure: Number of small businesses enrolled through MHC on first day of 4 MHC Measure: Number of individuals that attempt to obtain coverage through the (MHC) during the 5 MHC Measure: Number of employers that attempt to obtain coverage through MHC during the 30 days Monthly Total number of individual enrolled in the MHC 30 days Monthly Total number of MAGI Medicaid enrolled in the MHC 30 days Monthly Total number of small businesses enrolled in the MHC 30 days Monthly The total number of unique person-level IDs that are generated when an individual creates an account in the MHC. Useful in tracking the overall traffic into the MHC and changes in demand over time. 30 days Collect and The total number of unique employer IDs that are report ly generated when a business creates an account in the MHC. Page 1

2 6 MHC Measure: Number of employers 30 Days Collect and Number of employers who facilitate insurance that facilitate coverage through the MHC during the report ly enrollment through the exchange. It is important to measure the impact of the exchange on employers and on their workers. 8 MHC Measure: Number of employers eligible for a tax credit that facilitate 30 Days Collect and report ly See above description 9 MHC Measure: Number of employers not eligible for a tax credit that facilitate 10 MHC Measure: Number of employers not eligible for a tax credit who did not offer coverage previously that facilitate 11 MHC Measure: Number of employers not eligible for a tax credit who offered coverage previously that facilitate A. Outcome Measure: Percentage of adults who cannot afford a doctor visit 30 Days Collect and See above description report ly 30 Days Collect and See above description report ly 30 Days Collect and See above description report ly AFFORDABILITY Maryland Department of Health and Behavioral Risk Factor Surveillance Mental Hygiene (DHMH) Survey 5-6 s Semiannual Number of adults who could not see a doctor due to cost. This statewide measure is useful for tracking overall trends in affordability. In addition, by focusing on this specific aspect of the concept, the exchange can use the measure to tell the affordability story from a very personal point of view. B. Outcome Measure: Percent of families with high cost burden Federal survey data: Current Population Survey MHCC New 9-10 s Annually The percent of families that spends more than 10% of their income on premiums and out-of-pocket spending statewide. By highlighting total spending, both premiums and out-of-pocket spending, this statewide measure provides a comprehensive view of affordability. Because this measure is at the family level, it is easy for individuals to relate to and therefore useful for illustrating affordability gains to the public. 1 MHC Measure: Number of individuals receiving premium subsidies on the first day of the 30 days Monthly The number of individuals receiving some level of premium subsidy. Page 2

3 2 MHC Measure: Number of individuals receiving cost sharing subsidies on the first day of the 1 MHC Measure: Application processing time for individuals who enroll through the MHC on their own during the 30 days Monthly The number of individuals receiving cost sharing subsidies. A primary function of the exchange is to facilitate the transfer of premium and cost sharing subsidies to individuals. Monitoring the number of people receiving a subsidy, as well as the value of the subsidy, will both highlight the successful functioning of the exchange and help track the federal resource allocation to this provision of the ACA. CONSUMER SATISFACTION 2 MHC Measure: Application processing time for individuals who enroll through the MHC with the assistance of a Navigator or Assister during the 30 days Monthly Time from creation of an account to eligibility determination. Although this does not measure consumer attitudes directly, it is an early driver of satisfaction and will be important to monitor along with direct measures of satisfaction. It can also provide useful context for other measures of satisfaction. 30 days Monthly See above description 3 MHC Measure: Number of individual MHC grievances filed during the 30 days Monthly Total number of grievances filed with the exchange. Though this measure is fairly blunt and high level, the data that support it are continually generated and can provide a close to real time view of consumer satisfaction with the exchange. This tracking can indicate individual attitudes toward the exchange in various areas. If these more detailed breakdowns are available, it can signal areas of success and areas where improvement is needed. 4 MHC Measure: Number of SHOP grievances filed during the 30 days Monthly See above description Page 3

4 5 MHC Measure: Composite measure of satisfaction 1 year Annually A measure that combines multiple dimensions of individual consumer satisfaction. A satisfaction survey is the most direct and reliable way to gauge individual perceptions of the exchange and of health insurance coverage more specifically. By creating a composite measure, many aspects of consumer satisfaction can be reflected in a single measure that is easy to display and monitor over time. When this measure is produced, it can reference more detailed survey measures to explain trends and highlight specific areas of note. 6 MHC Measure: Composite measure of satisfaction by individual market enrollee 7 MHC Measure: Composite measure of satisfaction by SHOP enrollee 8 MHC Measure: Composite measure of satisfaction by MAGI Medicaid/MHCP enrollee 9 MHC Measure: Composite measure of satisfaction by metal level 10 MHC Measure: CSC call abandonment rate (Individual MHC queue) Goal: Less than 3% 11 MHC Measure: CSC call abandonment rate (SHOP MHC queue) Goal: Less than 3% 12 MHC Measure: CSC service level - % of calls answered within 30 seconds (Individual MHC queue) Goal: 85% of calls answered within 30 seconds 13 MHC Measure: CSC service level - % of calls answered within 30 seconds (SHOP MHC queue) Goal: 85% of calls answered within 30 seconds Page 4

5 A. Outcome Measure: Number of covered lives with non group coverage STABILITY NAIC Medical Loss Ratio Financial Reporting B. Outcome Measure: Number of covered lives with ESI C. Outcome Measure: Number of employers offering coverage D. Outcome Measure: Percent of employees in firms that offer coverage E. Outcome Measure: Percent of employees that are enrolled in ESI 1 MHC Measure: Number of Individuals exempt from the mandate NAIC 12 s Annually Number covered lives in the state. This measure can be used to track the overall stability of Maryland s insurance markets. Tracking covered lives both provides an idea for the size and stability of each of the markets, which can inform issues of overall stability and affordability. NAIC Medical Loss Ratio Financial NAIC 12 s Annually Reporting See above description MEPS-IC MHCC 12 s Annually Number of private-sector employers that offer insurance, statewide MEPS-IC MHCC 12 s Annually Percent of private-sector employees in establishments that offer insurance. MEPS-IC MHCC 12 s Annually Percent of private-sector employees who are eligible for and enroll in coverage. When thinking about insurance market stability, it is crucial to understand the changing dynamics of the market s foundation ESI. This measures and those above have key implications for the sustainability of the exchange. Specifically, if ESI offer and coverage rates decline, an increasing number of people will be eligible for public coverage or subsidies thus raising the cost to the state and federal government. From an employer perspective, this measure provides insights into employers decisions about whether to offer or drop coverage. MHBE - Administrative data 30 days Monthly Number of individuals exempt from the insurance coverage mandate for any reason. The stability of the exchange relies in part on strong and stable participation. By tracking this measure the exchange has another measure for monitoring the overall strength of the exchange. This measure can also inform stability by providing a gauge of affordability, particularly over time. Specifically, if subsidies are not sufficient to offset costs or premiums increase faster than wage growth, individuals will find coverage through the exchange unaffordable and will increasingly seek exemptions. Page 5

6 HEALTH EQUITY Healthy Equity certain metrics from each category may also be measured by such characteristics as race, age, income, geography, disability, sexual orientation and/or language and analyzed on a quarterly basis. Those measured in this category are indicated with green font. Page 6