SCDHHS Accountability Report: Fiscal Year 2018-2019South Carolina Department of Health and Human Services
SCDHHS
Organization_d0cb71e8-6cce-4864-9ecf-182e536d8bbaJoshua D. BakerAgency Director[To be named]To be a responsive and innovative organization that continuously improves the health of South Carolina.Vision_751f61ec-3982-4836-82b4-446f68643beaTo purchase the most health for our citizens in need at the least possible cost for taxpayers.Mission_751f61ec-3982-4836-82b4-446f68643beaunnamed valueMedicaidProvide better health outcomes for Medicaid beneficiariesGoal_bd3215a4-423d-4aaf-9321-b1f4a2df05851Department of Health and Environmental ControlDHEC is an important service provider and information source for Medicaid beneficiaries. Associated Goal(s): 1.2.1; 3.1.1; 3.2.1DataData used in program development and management (obesity, immunizations, etc.)Managed Care OrganizationsCoordination & Cost ControlThe program's five managed care organizations are responsible for coordinating care and controlling costs for most Medicaid beneficiaries. Associated Goal(s): 1.1.1; 1.1.2; 3.1.1; 3.2.1Medicaid BeneficiariesMedicaid members and/or applicants -- Division/Program: Eligibility and Health Services Service/Product Provided to Customers: Health coverage for members Customer Segment: Public Demographic: Low-income and/or disabled residents who meet categorical requirements.[To be named]ProvidersRoughly 48,000 individuals and organizations are currently enrolled to provide services to Medicaid beneficiaries, including physicians, dentists, and countless other classes. Associated Goal(s): 1.1.1; 1.1.2; 3.1.1; 3.2.1TelemedicineUse of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs.PaymentsExpand the use of value-based payment methodologiesObjective_cc154eaa-46db-4c6a-b5ed-5b2da8609b311Managed Care OrganizationsCoordination & Cost ControlThe program's five managed care organizations are responsible for coordinating care and controlling costs for most Medicaid beneficiaries. Associated Goal(s): 1.1.1; 1.1.2; 3.1.1; 3.2.1ProvidersRoughly 48,000 individuals and organizations are currently enrolled to provide services to Medicaid beneficiaries, including physicians, dentists, and countless other classes. Associated Goal(s): 1.1.1; 1.1.2; 3.1.1; 3.2.1TelemedicineUse of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs.1HEDIS Withhold Metrics IncreasePercentagePerformanceIndicator_8e81764c-a4eb-4cdb-9ef2-ff55fc93a7c7Time Applicable: 7/1/2018-6/30/2019 (measurements not available until Aug) Data Source and Availability: MCO HEDIS submission. Calculation Method: Number of measure above 50%/total number of measures. Meaningful Use of Measure: Provide better health outcomes for Medicaid beneficiaries and expand the use of value-based payment methodologies.2018-07-0192Base: 92%2018-07-012019-06-3094Increase the percentage of HEDIS withhold metrics at or above the 50th percentile by 2% annually. Target: 94%2018-07-012019-06-300Actual: TBD574994b6-f171-4c9c-be21-184c34c3dfe41Value-Based ApproachPercentagePerformanceIndicator_02ba106d-b520-43d4-81ba-5d1ded617dc4Time Applicable: 1/1/2018-12/31/2018 (measurements not available until May) Data Source and Availability: MCO Attestation. Calculation Method: Percentage of MCO claims dollars paid subject to VOC contract. Meaningful Use of Measure: Provide better health outcomes for Medicaid beneficiaries and expand the use of value-based payment methodologies.2018-01-0132Base: 32%2018-01-012018-12-310Actual: TBD2018-01-012018-12-3130Provide at least 30% of managed care payment using a value-based approach. Target: 30%174c9196-16d1-430d-b9dd-59e477049cb3Birth OutcomesBuild upon the success of the Birth Outcomes InitiativeObjective_93a54e0a-7e3b-4242-b611-85040b6ee8ad2Department of Health and Environmental ControlDHEC is an important service provider and information source for Medicaid beneficiaries. Associated Goal(s): 1.2.1; 3.1.1; 3.2.1DataData used in program development and management (obesity, immunizations, etc.)1Low Birth Weight ReductionPercentagePerformanceIndicator_ac9cf0ba-aa5d-4abc-8f8f-d42ed107863eTime Applicable: 1/1/2018-12/31/2018 Data Source and Availability: Truven Analytics - Advantage Suite. Calculation Method: Percentage of live birth deliveries with diagnosis of birth weight below 2,500 mg. Meaningful Use of Measure: Provide better health outcomes for Medicaid beneficiaries and build upon the success of the Birth Outcomes Initiative.2018-07-010Base: 11%2018-07-012019-06-300Actual: TBD2018-07-012019-06-309.02Reduce the rate of low birth weight babies by 3%. Target: 9.02%4e567341-c07f-4ab8-854a-b514d0d0e310Member ServicesProvide outstanding member servicesGoal_b7581a17-aaa6-4da6-bd47-6f870c0134432[To be named][To be named][To be named][To be named][To be named][To be named]TechnologyUse new technologies to improve the member service experienceObjective_5bb6797f-b79f-45af-b68a-b2acfeebb0bd1[To be named][To be named]1Online ApplicationsNumberPerformanceIndicator_6ecc5b19-84c2-4d14-b660-5d5dcc9f14d5Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Electronic Document Management System. Calculation Method: Total Online Apps Submitted Meaningful Use of Measure: Provide outstanding member services and use new technologies to improve the member service experience.2018-07-0134027Base: 3402700%2018-07-012019-06-3037430Increase the number of online applications by 10%. Target: 37,4302018-07-012019-06-300Actual: TBDb4670258-49ca-46e1-90a8-2fabe1699bc3Applications & ReviewsImprove processing time and resolution rates for applications and reviewsObjective_1a119110-f902-4741-9ddc-b7bc49f3787e2[To be named][To be named]1Case ResolutionPercentagePerformanceIndicator_7aeb3bc7-2449-4a42-9a46-b06bc58fd694Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Pathos. Calculation Method: Number of single-touch resolutions/total resolutions. Meaningful Use of Measure: Provide outstanding member services and improve processing time and resolution rates for applications and reviews.2018-07-010Actual: TBD2018-07-0170Base: 70%2018-07-012019-06-3077Increase the rates of single-touch case resolutions for applications and reviews by 10%. Target: 77%b7dddf00-aa08-43ff-bb8a-9abf53f3641e1Walk-In ResolutionPercentagePerformanceIndicator_c1d71304-de6c-44dd-aa53-dfce60cb8151Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Pathos. Calculation Method: Number of one-hour resolutions/total resolutions. Meaningful Use of Measure: Provide outstanding member services and improve processing time and resolution rates for applications and reviews.2018-07-0171Base: 71%2018-07-012019-06-300[To be determined]2018-07-012019-06-3078Increase the rate of one-hour resolution for walk-in services by 10%. Target: 78% Actual: TBD30f5b742-a89c-4371-87ce-13930da80acbFiscal StewardshipPromote sound fiscal stewardshipGoal_42491c0b-fa03-4f03-b29a-8a10fa2453ac3Department of Alcohol and Other Drug Abuse ServicesDAODAS receives significant funding from HHS and the agencies collaborate to discuss/design Medicaid service offerings. Associated Goal(s): 3.1.1; 3.2.1Cost & Quality ControlCost, quantity, and quality of services provided to D&A clients.Department of Mental HealthDMH is a major provider of behavioral health services for Medicaid beneficiaries. Associated Goal(s): 3.1.1; 3.2.1Behavioral Health ServicesAccess to and cost of behavioral health servicesDatadata on the sponsored housing program for chronically mentally ill individuals.Department of EducationAssociated Goal(s): 3.1.1; 3.2.1Cost & Quality ControlCost, quantity, and quality of services provided in school-based settings or for PreK-12 students.IntermediarySCDE has traditionally served as an intermediary between HHS and the school districts that provide Medicaid-funded services.Continuum of CareAssociated Goal(s): 3.1.1; 3.2.1Service ManagementContinuum manages services for children needing the most intensive behavioral health assistance; these services are often Medicaid-funded.Cost & Quality ControlCost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance.Lt. Governor's OfficeAssociated Goal(s): 3.1.1; 3.2.1DataEnrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services.CollaborationThe agencies collaborate on enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long-term care or nursing facility services.Department of Disabilities and Special NeedsAssociated Goal(s): 3.1.1; 3.2.1WaiversDDSN administers certain waiver programs on behalf of HHS; DDSN is primarily financed through HHS.FinancingAdministrative costs, service delivery costs, time required to move individuals off of waiting lists and into servicesDepartment of Social ServicesMany Medicaid beneficiaries also receive some form of services through DSS (SNAP, TANF, foster care, etc.). Associated Goal(s): 3.1.1; 3.2.1CollaborationThe agencies collaborate on eligibility and to serve certain populations.Cost ControlCost/quantity of services authorized for and/or care coordinated for children in therapeutic foster careMetricsmetrics tied to Medicaid administrative activities and DSS activities related to carrying out the Medicaid State Plan; capitation rates for foster children.Medical University of South CarolinaAssociated Goal(s): 3.1.1; 3.2.1Telemedicine AdministrationMUSC administers the statewide telemedicine system that is funded with resources from HHS. Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs.[To be named][To be named][To be named][To be named][To be named][To be named]BudgetDevelop reliable budget forecasts and mid-year correction mechanismsObjective_02e854cc-4285-4946-b88c-78df2000194b1Continuum of CareAssociated Goal(s): 3.1.1; 3.2.1Service ManagementContinuum manages services for children needing the most intensive behavioral health assistance; these services are often Medicaid-funded.Cost & Quality ControlCost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance.Medical University of South CarolinaAssociated Goal(s): 3.1.1; 3.2.1Telemedicine AdministrationMUSC administers the statewide telemedicine system that is funded with resources from HHS. Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs.Department of Disabilities and Special NeedsAssociated Goal(s): 3.1.1; 3.2.1FinancingAdministrative costs, service delivery costs, time required to move individuals off of waiting lists and into servicesWaiversDDSN administers certain waiver programs on behalf of HHS; DDSN is primarily financed through HHS.Department of Alcohol and Other Drug Abuse ServicesDAODAS receives significant funding from HHS and the agencies collaborate to discuss/design Medicaid service offerings. Associated Goal(s): 3.1.1; 3.2.1Cost & Quality ControlCost, quantity, and quality of services provided to D&A clients.Department of Social ServicesMany Medicaid beneficiaries also receive some form of services through DSS (SNAP, TANF, foster care, etc.). Associated Goal(s): 3.1.1; 3.2.1Cost ControlCost/quantity of services authorized for and/or care coordinated for children in therapeutic foster careCollaborationThe agencies collaborate on eligibility and to serve certain populations.Metricsmetrics tied to Medicaid administrative activities and DSS activities related to carrying out the Medicaid State Plan; capitation rates for foster children.Department of Mental HealthDMH is a major provider of behavioral health services for Medicaid beneficiaries. Associated Goal(s): 3.1.1; 3.2.1Datadata on the sponsored housing program for chronically mentally ill individuals.Behavioral Health ServicesAccess to and cost of behavioral health servicesDepartment of EducationAssociated Goal(s): 3.1.1; 3.2.1Cost & Quality ControlCost, quantity, and quality of services provided in school-based settings or for PreK-12 students.IntermediarySCDE has traditionally served as an intermediary between HHS and the school districts that provide Medicaid-funded services.Lt. Governor's OfficeAssociated Goal(s): 3.1.1; 3.2.1CollaborationThe agencies collaborate on enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long-term care or nursing facility services.DataEnrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services.1General Fund ExpendituresPercentagePerformanceIndicator_2e60cb5b-a5c4-4740-92ea-fc6a2e165173Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Business Objects - Monthly. Calculation Method: ((Forecast- Actuals)/forecast)*100 Meaningful Use of Measure: Promotes sound fiscal stewardship and allows the agency to control increases in healthcare spending2018-07-012Base: <2%2018-07-012019-06-300Actual: TBD2018-07-012019-06-303Maintain General Fund expenditures within 3% of forecast. Target: <3%771ad5f0-a6d9-4068-91d4-91a517e1d1d4Healthcare SpendingControl increases in healthcare spendingObjective_bec40b63-b278-4048-92a8-d63b93ba0df82[To be named][To be named]1Cost IncreasesPercentagePerformanceIndicator_00a3578b-48fb-4627-8150-15b358bcc09fTime Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Expenses from Business Objects, Eligibility from Document Direct - Monthly. Calculation Method: "PMPM - expenses/#enrolled/ PMPM growth = (PMPM FY17-PMPM FY16)/PMPM FY16)" Meaningful Use of Measure: Promotes sounds fiscal stewardship and controls increases in healthcare spending2018-07-012019-06-302.1Keep per-member cost increases below national benchmarks. Base: PMPM Growth: 2.1% HC Cost Growth: 2.5% Target: Less than health care cost growth2018-07-012019-06-300Actual: TBDa81137be-c743-41d2-8248-faf039451610Waste, Fraud & AbusePrevent waste, fraud and abuseObjective_0f1f2399-25c3-4720-ada1-5ed34d552fe63[To be named][To be named]1Expenditures AnalyzedPercentagePerformanceIndicator_53dca34f-877b-4c43-adc1-94bec4254363Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Truven Analytics - Advantage Suite. Calculation Method: (Expenditures Reviewed by TPL)/(Total TPL Potential) Meaningful Use of Measure: Promotes sounds fiscal stewardship and prevents waste, fraud and abuse2018-07-0186Base: 86%2018-07-012019-06-300Actual: TBD2018-07-012019-06-3093Increase the percentage of expenditures analyzed for third-party liability by 5%. Target: 90.3%8a8fe0b0-c6f5-4d50-8fc3-0817db261264ManagementProvide responsive and responsible management of health and human service programsGoal_faeb432e-3ab0-4905-933b-81d1f41ccf214[To be named][To be named][To be named][To be named][To be named][To be named]Provider RelationsEnsure timely handling of provider relationsObjective_240e8752-a945-48ea-b7d6-9c7f1b7792ac1[To be named][To be named]1Applications Processed on TimePercentagePerformanceIndicator_fee65493-a944-4162-8d21-999802d51308Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: iFlow. Calculation Method: Applications over 30 days / Total applications Meaningful Use of Measure: Provide responsive and responsible management of health and human service programs and ensure timely handling of provider relations2018-07-01100Base: 100%2018-07-012019-06-300Actual: TBD2018-07-012019-06-3099Process 99% of provider applications within 30 days. Target: 99 %86111d9f-ac47-40bb-91a0-7c93101c19ee1Claims Processed on TimePercentagePerformanceIndicator_23c00ba7-4fa9-45c6-9de9-b3ee0d594905Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: MMIS; Document Direct. Calculation Method: Document Direct (CLM4710R01 - Monthly Prompt Payment Compliance Report); Average of 30 Day Period % column Meaningful Use of Measure: Provide responsive and responsible management of health and human service programs and ensure timely handling of provider relations2018-07-01100Base: 100%2018-07-012019-06-300Actual: TBD2018-07-012019-06-3099Process 99% of electronic claims submissions within 14 days. Target: 99 %e85d4ccf-36e7-4d7e-acea-232325d88584Workforce EngagementDevelop and maintain a committed and engaged workforceObjective_aca05049-35e4-4028-963b-48ae5a38b3662[To be named][To be named]1Engagement ScorePercentagePerformanceIndicator_49d7b907-5ee1-400b-9ebf-ab4c2df0e1c3Time Applicable: 7/1/2018-6/30/2019 Data Source and Availability: Third party engagement survey administered in fall . Calculation Method: Calculated as part of third party engagement survey that generates an "Overall Engagement Score" Meaningful Use of Measure: Develop and maintain a committed and engaged workforce to deliver responsive and efficient health and human service programs2018-07-010Base: 50%2018-07-012019-06-3052.5Improve employee engagement scores by 5% Target: 52.5%2018-07-012019-06-300Actual: TBDa8ae086c-a48d-4e9a-bb36-fc5fd0311ef4StrategyPlan_751f61ec-3982-4836-82b4-446f68643bea2018-07-012019-06-302021-11-06Submitter_751f61ec-3982-4836-82b4-446f68643beaOwenAmbur