Table 5.
Primary Health Care Organization Performance Metrics Summary
| Domain | Australia Medicare Locals (MLs) | Colorado Regional Care Collaborative Organizations (RCCOs)3 | North Carolina Networks4 | Oregon Coordinated Care Organizations |
|---|---|---|---|---|
| Preventive care (Primary care services) | Life expectancy1; adult overweight or obese1; general practitioner visits1; tobacco use1; health promotion activities; access to after-hours care | Well-child (age 3–9) visits2; postpartum visits2 | Effective contraceptive use2; timely prenatal and postpartum care2; child dental sealants2; adolescent well-child visits2; health assessments for foster children2; obesity; tobacco use | |
| Screenings, tests, vaccines | Immunization rates for 1- and 3-year-olds1; immunization coverage rates for children | Depression screening and follow-up2; colorectal screening2; child developmental screening (in first 36 months)2; low birth weight; alcohol and substance abuse screening2 | ||
| Managing chronic care | Potentially avoidable deaths1; primary care services for aged care facility residents | Medication reconciliation for high-risk patients; care management and assessment for at-risk Aged, Blind, and Disabled patients | Follow-up after hospitalization for mental illness2; high blood pressure control2; diabetes control2 | |
| Patient experience, satisfaction, engagement | Waiting times for general practitioner and specialists appointments1; cost barriers for general practitioners' and specialists' care1; cost barriers for prescription medications1; ML understanding of patient experience with local health care; ML engagement with consumers | Adult and child access to care2 and satisfaction with care2; getting timely needed care; adult health status | ||
| Utilization | Adult emergency department visits1; adult hospital admissions1; preventable hospital admissions1; specialists visits1; allied health or nurse visits1 | Emergency department visits2 | Emergency department visits and hospital admissions; preventable hospital readmissions; generic prescription use | Emergency department visits2; preventable emergency department visits; all-cause hospital readmissions |
| Practice transformation | Percentage of providers e-prescribing | Electronic health record adoption2; medical home enrollment2 |
National Health Performance Authority 2013 metric.
Incentive metric aligned with performance payment.
According to Colorado Department of Health Care Policy and Financing, these metrics represent the key performance indicators and are aligned with payment. RCCOs are assessed on numerous other metrics as well.
North Carolina networks are assessed on numerous clinical measures provided through claims data and chart reviews.
Source/Notes: Author's analysis of data from the following government documents and Web sources:
Australia metrics: Metrics with superscript are from the National Health Performance Authority. http://www.myhealthycommunities.gov.au/Content/publications/downloads/NHPA_HC_Report_Avoidable_deaths_life_expectancy_December_2013.pdf. The other metrics are from Australian Government Department for Health and Ageing, Medicare Local Operational Guidelines. Canberra [Australia]: Australian Government; April 2013.
Colorado metrics: Colorado Department of Health Care Policy & Financing. ACC Incentive Payments Fact Sheet. April 2015. https://www.colorado.gov/pacific/sites/default/files/KPI%20Incentive%20Fact%20Sheet.pdf.
North Carolina metrics: North Carolina Department of Health and Human Services. 2009 Report to the General Assembly. Raleigh, NC: NC Department of Health and Human Services; 2009.
Oregon metrics: Oregon Health Authority. Oregon's Health System Transformation: 2014 Mid-Year Report. January 2015. http://www.oregon.gov/oha/Metrics/Documents/2014%20Mid-Year%20Report%20-%20Jan%202015.pdf.