| Measure ID |
Title |
Description |
Weight |
Subcategory ID |
|
IA_AHE_1
|
Engagement of new Medicaid patients and follow-up
|
Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare.
|
High |
Achieving Health Equity |
|
IA_AHE_2
|
Leveraging a QCDR to standardize processes for screening
|
Participation in a QCDR, demonstrating performance of activities for use of standardized processes for screening for social determinants of health such as food security, employment and housing. Use of supporting tools that can be incorporated into the certified EHR technology is also suggested.
|
Medium |
Achieving Health Equity |
|
IA_AHE_3
|
Leveraging a QCDR to promote use of patient-reported outcome tools
|
Participation in a QCDR, demonstrating performance of activities for promoting use of patient-reported outcome (PRO) tools and corresponding collection of PRO data (e.g., use of PQH-2 or PHQ-9 and PROMIS instruments).
|
Medium |
Achieving Health Equity |
|
IA_AHE_4
|
Leveraging a QCDR for use of standard questionnaires
|
Participation in a QCDR, demonstrating performance of activities for use of standard questionnaires for assessing improvements in health disparities related to functional health status (e.g., use of Seattle Angina Questionnaire, MD Anderson Symptom Inventory, and/or SF-12/VR-12 functional health status assessment).
|
Medium |
Achieving Health Equity |
|
IA_BE_1
|
Use of certified EHR to capture patient reported outcomes
|
In support of improving patient access, performing additional activities that enable capture of patient reported outcomes (e.g., home blood pressure, blood glucose logs, food diaries, at-risk health factors such as tobacco or alcohol use, etc.) or patient activation measures through use of certified EHR technology, containing this data in a separate queue for clinician recognition and review.
|
Medium |
Beneficiary Engagement |
|
IA_BE_10
|
Participation in a QCDR, that promotes implementation of patient self-action plans.
|
Participation in a QCDR, that promotes implementation of patient self-action plans.
|
Medium |
Beneficiary Engagement |
|
IA_BE_11
|
Participation in a QCDR, that promotes use of processes and tools that engage patients for adherence to treatment plan.
|
Participation in a QCDR, that promotes use of processes and tools that engage patients for adherence to treatment plan.
|
Medium |
Beneficiary Engagement |
|
IA_BE_12
|
Use evidence-based decision aids to support shared decision-making.
|
Use evidence-based decision aids to support shared decision-making.
|
Medium |
Beneficiary Engagement |
|
IA_BE_13
|
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
|
Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
|
Medium |
Beneficiary Engagement |
|
IA_BE_14
|
Engage patients and families to guide improvement in the system of care.
|
Engage patients and families to guide improvement in the system of care.
|
Medium |
Beneficiary Engagement |
|
IA_BE_15
|
Engagement of patients, family and caregivers in developing a plan of care
|
Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology.
|
Medium |
Beneficiary Engagement |
|
IA_BE_16
|
Evidenced-based techniques to promote self-management into usual care
|
Incorporate evidence-based techniques to promote self-management into usual care, using techniques such as goal setting with structured follow-up, Teach Back, action planning or motivational interviewing.
|
Medium |
Beneficiary Engagement |