Common use of Kentucky Healthcare Outcomes Clause in Contracts

Kentucky Healthcare Outcomes. The Contractor’s Quality Management and performance improvement approach shall incorporate rigorous outcomes measurement against relevant targets and benchmarks. All health goals, outcomes, and indicators shall comply with Federal requirements established under 42 C.F.R. 438.240 (C) (1) and (C) (2) relating to Contractor performance and reporting. The Department will specify the required performance and outcomes measures that the Contractor shall address, including Health Care Effectiveness Data and Information Set (HEDIS™) measures and Kentucky- specific measures. Performance measures, benchmarks, and/or specifications may be modified by the Department over the course of the Contract to comply with industry standards and updates, as well as to focus on particular outcomes. The Department will provide the Contractor with at least ninety (90) Days’ notice, when possible, to make administrative changes to comply with any new measurement requirements. A. The Department will set specific quantitative performance targets and goals, and the Contractor shall be expected to achieve demonstrable and sustained improvement for each measure. Minimum performance levels shall be specified for each performance improvement area derived from regional or national standards or from standards established by an appropriate practice organization. B. The Contractor shall report activities to address the performance measures in the QAPI Plan quarterly and shall submit an annual report after collection of performance data. The Contractor shall make comparisons across data for each measure by the Medicaid geographic regions, eligibility category, race ethnicity, gender and age to the extent such information has been provided by the Department to Contractor. The Contractor shall incorporate consideration of social determinants of health into the process for analyzing data to support population health management. Reported information may be used to determine disparities in health care. The Contractor shall submit a plan to the Department for initiatives and activities the Contractor will implement to address identified disparities. C. The Contractor shall continually work to improve health outcomes from year to year and sustain such improvements. The Department shall assess the Contractor’s achievement of performance improvement as evidenced by health outcome measurement results on an annual basis unless otherwise specified by the Department. D. Where achievement is lagging in progress towards meeting performance measure targets, the Department will consider the following: 1. Opportunities across MCOs to collaborate to understand challenges and work with the MCOs to identify opportunities to coordinate efforts to work towards improvement. The Contractor shall actively participate in collaborative efforts, including providing data and other materials to help inform options. 2. Need for the Contractor to develop and implement a corrective action plan that addresses the lack of achievements and identifies steps that will lead toward improvements. The Contractor shall submit the plan to the Department within thirty (30) Calendar Days of receipt of notification of required corrective action. 3. Implementation of penalties, as deemed appropriate by the Department due to Contractor failure to make improvements. See Appendix B “Remedies for Violation, Breach, or Non-Performance of Contract” for information about penalties.

Kentucky Healthcare Outcomes. The Contractor’s Quality Management and performance improvement approach shall incorporate rigorous outcomes measurement against relevant targets and benchmarksbenchmarks . All health goals, outcomes, and indicators shall comply with Federal requirements established under 42 C.F.R. 438.240 (C) (1) and (C) (2) relating to Contractor performance and reporting. The Department will specify the required performance and outcomes measures that the Contractor shall address, including Health Care Effectiveness Data and Information Set (HEDIS™) measures and Kentucky- specific measures. Performance measures, benchmarks, and/or specifications may be modified by the Department over the course of the Contract to comply with industry standards and updates, as well as to focus on particular outcomes. The Department will provide the Contractor with at least ninety (90) Days’ notice, when possible, to make administrative changes to comply with any new measurement requirements. A. The Department will set specific quantitative performance targets and goals, and the Contractor shall be expected to achieve demonstrable and sustained improvement for each measure. Minimum performance levels shall be specified for each performance improvement area derived from regional or national standards or from standards established by an appropriate practice organization. B. The Contractor shall report activities to address the performance measures m easures in the QAPI Plan quarterly and shall submit an annual report after collection of performance data. The Contractor shall make comparisons across data for each measure by the Medicaid geographic regions, eligibility category, race ethnicity, gender and age to the extent such information has been provided by the Department to Contractor. The Contractor shall incorporate consideration of social determinants of health into the process for analyzing data to support population health management. Reported information may be used to determine disparities in health care. The Contractor shall submit a plan to the Department for initiatives and activities the Contractor will implement to address identified disparities. C. The Contractor shall continually work to improve health outcomes from year to year and sustain such improvements. The Department shall assess the Contractor’s achievement of performance improvement as evidenced by health outcome measurement results on an annual basis unless otherwise specified by the Department. D. Where achievement is lagging in progress towards meeting performance measure targets, the Department will consider the following: 1. Opportunities across MCOs to collaborate to understand challenges and work with the MCOs to identify opportunities to coordinate efforts to work towards improvement. The Contractor shall actively participate in collaborative efforts, including providing data and other materials to help inform options. 2. Need for the Contractor to develop and implement a corrective action plan that addresses the lack of achievements and identifies steps that will lead toward improvementsimprovements . The Contractor shall submit the plan to the Department within thirty (30) Calendar Days of receipt of notification of required corrective action. 3. Implementation of penalties, as deemed appropriate by the Department due to Contractor failure to make improvements. See Appendix B “Remedies for Violation, Breach, or Non-Performance of Contract” for information about penalties.