The Hospital Transformation Program (HTP) is a value-based program for hospitals caring for Medicaid clients. The HTP requests that hospitals in the state of Colorado focus on the following primary goals:

  • Lower Health First Colorado (Colorado’s Medicaid program) costs through reductions in avoidable hospital utilization and increased effectiveness and efficiency in care delivery

  • Improve patient outcomes through care redesign and integration of care across settings; evidence-based care coordination and care transitions, integrated physical and behavioral care delivery, chronic care management, and community-based population health and disparities reduction efforts

  • Improve the patient experience in the delivery system by ensuring appropriate care in appropriate settings

Montrose Regional Health will focus on 6 statewide measures and 4 local measures to meet the unique needs of our community and that meet the goals of the Hospital Transformation Program.

We value our community’s input! If you have any questions or concerns with the select measures please email us at HTP@montrosehealth.com.

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If you have any questions or concerns about the Hospital Transformation Program, please email our HPT Team.

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SW-RAH1 – 30 day All-Cause Risk Adjusted Hospital Readmission

  • For Medicaid patients 18 years of age and older (18-64 years), the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. This measure is reported as the ratio of actual readmissions to expected readmissions based on risk adjustment for patient severity.

Data Source: Medicaid claims data

SW-CP1 – Social needs screening and notification

  • Measurement of the number of Medicaid patients discharged to home from an inpatient admission who have formal social needs screening during or within 12 months of the admission, results documented in the medical record and, if there is a positive social needs screen, referral to an appropriate entity and notification to the RAE utilizing a process that is mutually agreed upon.
  • A patient with a positive social needs screen must be referred to an appropriate entity and the RAE notified for the patient to be considered having met this measure and included in the numerator. Screening alone without appropriate referral and RAE notification for a patient who screens positive is not considered adequate for this measure. The measure is reported as one overall score counting all patients who are screened and screen negative, and patients with positive screens only if they are appropriately referred and the RAE is notified about them.
  • Social needs screening should include at a minimum five core domains consisting of housing instability; food insecurity; transportation problems; utility help needs and interpersonal safety

Data Source: Hospital self-report from EMR or medical records

CP5 – Reducing Neonatal Complications

Reduce Hospital Complications for Newborns

  • Reducing the percent of infants with unexpected newborn complications among full term newborns with no preexisting conditions.

Data Source: Hospital Chart Abstraction

CP6 – Screening and Referral for Perinatal and Post-Partum Depression and Anxiety and notification of positive screens to the Regional Accountable Entities (RAE)

Identify and Ensure Outpatient Follow Up for Pregnant and Post-Partum Patients with Depression or Anxiety

  • Percentage of pregnant Medicaid patients screened at any hospital encounter for perinatal and post-partum anxiety and depression during pregnancy and the postpartum period (60 days) with the RAE notified within one business day if the screen is positive.
  • The RAE must be notified within one business day if a patient has a positive screen for that patient to be considered having met this measure and included in the numerator. Screening alone without RAE notification for a patient who screens positive is not considered adequate for this measure. The measure is reported as one overall score counting all patients who are screened and screen negative, and patients with positive screens only if the RAE is notified about them within one business day.

Data Source: Hospital self-report from EMR or medical records

SW-BH1 – Collaboratively develop and implement a mutually agreed upon discharge planning and notification process with the appropriate RAE’s for eligible patients with a diagnosis of mental illness or substance use disorder (SUD) discharged from the hospital or ED

Ensure Appropriate Follow Up for Patients with Mental Illness or Substance Use Disorder Discharged from The Hospital or Emergency Room

  • Percentage of eligible Medicaid patients 18 years or older discharged from the hospital or emergency department to home with a principal or secondary diagnosis of mental illness or SUD with a collaboratively mutually agreed upon discharge planning process and notification process with or to the RAE within one business day.

Data Source: Hospital self-report from EMR or medical records

SW-BH3 – Using Alternatives to Opioids (ALTO’s) in hospital ED’s: Decrease use of opioids and Increase use of ALTO’s.

Ensure Appropriate Treatment of Pain in The Emergency Room

  • This two-part measure will track:
    1. Total per oral (PO) morphine equivalents units (MEUs) per 1,000 Emergency Department (ED) Visits for patient ages 18 year and older broken down by Pain Pathway.
    2. Total number of listed ALTO drugs of interest medications administered per 1,000 Emergency Department (ED) Visits for patient ages 18 year and older broken down by Pain Pathway.

Data Source: Numerator: Hospital self-report from EMR or medical records, Medication Administration Record (MAR). Denominator: EMR data, billing systems or other tracking systems

BH1 – Screening, Brief Intervention, Referral and Treatment (SBIRT) in the ED

Identify Patients with Alcohol or Substance Use Disorder in The Emergency Department and Refer for Appropriate Treatment

  • The percent of Medicaid ED patients age 12 years and older who are screened for alcohol or other substance use at the time of an ED visit and those who score positive have also received a brief intervention during the ED visit.
  • Screening alone without a brief intervention for patients who score positive is not considered adequate for this measure. The measure is reported as one overall score counting in the numerator all patients who are screened and screen negative, and patients with positive screens only if there is a brief intervention.

Data Source: Hospital self-report from EMR or medical records

BH2 – Initiation of Medication Assisted Treatment (MAT) in ED or Hospital Owned Certified Provider Based Rural Health Center

Initiate Medical Treatment in The Emergency Department or Rural Health Center for Patients with Opioid Use Disorder

  • The number of patients with an opioid use disorder (OUD) diagnosis for whom MAT with Buprenorphine, Methadone, or Naltrexone is initiated during an emergency department visit or hospital owned certified provider based rural health center.

Data Source: Hospital self-report

SW-COE1 – Hospital Index

Reduce Unnecessary Hospital Care

  • A measure of avoidable care across procedural episodes.

Data Source: Claims data

SW-PH1 – Severity Adjusted Length of Stay (LOS)

Improve Efficiency of Hospital Care

  • The Severity Adjusted Length of Stay (LOS) compared to the statewide average. This measure is reported as the ratio of actual average length of stay to expected average length of stay based on statewide average and risk adjustment for patient severity.
  • Days LOS Admit Acute is the average length of stay for acute admissions, defined as:
    • Days LOS Admit Acute = Days Admit Acute / Admits Acute
  • Acute Admissions identifies Medicaid admissions that took place in an acute inpatient setting. Acute inpatient settings include inpatient hospitals, birthing centers, inpatient psychiatric facilities, and residential substance abuse treatment facilities. The setting value is derived from the Admission record, Medstat Place Group Code value. The value is filtered to Group Code=1.

Data Source: Medicaid claims data