SCDHHS Accountability Report: Fiscal Year 2018-2019 South Carolina Department of Health and Human Services SCDHHS Organization_d0cb71e8-6cce-4864-9ecf-182e536d8bba Joshua D. Baker Agency Director [To be named] To be a responsive and innovative organization that continuously improves the health of South Carolina. Vision_751f61ec-3982-4836-82b4-446f68643bea To purchase the most health for our citizens in need at the least possible cost for taxpayers. Mission_751f61ec-3982-4836-82b4-446f68643bea unnamed value Medicaid Provide better health outcomes for Medicaid beneficiaries Goal_bd3215a4-423d-4aaf-9321-b1f4a2df0585 1 Department of Health and Environmental Control DHEC is an important service provider and information source for Medicaid beneficiaries. Associated Goal(s): 1.2.1; 3.1.1; 3.2.1 Data Data used in program development and management (obesity, immunizations, etc.) Managed Care Organizations Coordination & Cost Control The 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; 3.2.1 Medicaid Beneficiaries Medicaid 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] Providers Roughly 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; 3.2.1 Telemedicine Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs. Payments Expand the use of value-based payment methodologies Objective_cc154eaa-46db-4c6a-b5ed-5b2da8609b31 1 Managed Care Organizations Coordination & Cost Control The 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; 3.2.1 Providers Roughly 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; 3.2.1 Telemedicine Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs. 1 HEDIS Withhold Metrics Increase Percentage PerformanceIndicator_8e81764c-a4eb-4cdb-9ef2-ff55fc93a7c7 Time 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. 2018-07-01 92 Base: 92% 2018-07-01 2019-06-30 94 Increase the percentage of HEDIS withhold metrics at or above the 50th percentile by 2% annually. Target: 94% 2018-07-01 2019-06-30 0 Actual: TBD 574994b6-f171-4c9c-be21-184c34c3dfe4 1 Value-Based Approach Percentage PerformanceIndicator_02ba106d-b520-43d4-81ba-5d1ded617dc4 Time 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. 2018-01-01 32 Base: 32% 2018-01-01 2018-12-31 0 Actual: TBD 2018-01-01 2018-12-31 30 Provide at least 30% of managed care payment using a value-based approach. Target: 30% 174c9196-16d1-430d-b9dd-59e477049cb3 Birth Outcomes Build upon the success of the Birth Outcomes Initiative Objective_93a54e0a-7e3b-4242-b611-85040b6ee8ad 2 Department of Health and Environmental Control DHEC is an important service provider and information source for Medicaid beneficiaries. Associated Goal(s): 1.2.1; 3.1.1; 3.2.1 Data Data used in program development and management (obesity, immunizations, etc.) 1 Low Birth Weight Reduction Percentage PerformanceIndicator_ac9cf0ba-aa5d-4abc-8f8f-d42ed107863e Time 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. 2018-07-01 0 Base: 11% 2018-07-01 2019-06-30 0 Actual: TBD 2018-07-01 2019-06-30 9.02 Reduce the rate of low birth weight babies by 3%. Target: 9.02% 4e567341-c07f-4ab8-854a-b514d0d0e310 Member Services Provide outstanding member services Goal_b7581a17-aaa6-4da6-bd47-6f870c013443 2 [To be named] [To be named] [To be named] [To be named] [To be named] [To be named] Technology Use new technologies to improve the member service experience Objective_5bb6797f-b79f-45af-b68a-b2acfeebb0bd 1 [To be named] [To be named] 1 Online Applications Number PerformanceIndicator_6ecc5b19-84c2-4d14-b660-5d5dcc9f14d5 Time 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. 2018-07-01 34027 Base: 3402700% 2018-07-01 2019-06-30 37430 Increase the number of online applications by 10%. Target: 37,430 2018-07-01 2019-06-30 0 Actual: TBD b4670258-49ca-46e1-90a8-2fabe1699bc3 Applications & Reviews Improve processing time and resolution rates for applications and reviews Objective_1a119110-f902-4741-9ddc-b7bc49f3787e 2 [To be named] [To be named] 1 Case Resolution Percentage PerformanceIndicator_7aeb3bc7-2449-4a42-9a46-b06bc58fd694 Time 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. 2018-07-01 0 Actual: TBD 2018-07-01 70 Base: 70% 2018-07-01 2019-06-30 77 Increase the rates of single-touch case resolutions for applications and reviews by 10%. Target: 77% b7dddf00-aa08-43ff-bb8a-9abf53f3641e 1 Walk-In Resolution Percentage PerformanceIndicator_c1d71304-de6c-44dd-aa53-dfce60cb8151 Time 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. 2018-07-01 71 Base: 71% 2018-07-01 2019-06-30 0 [To be determined] 2018-07-01 2019-06-30 78 Increase the rate of one-hour resolution for walk-in services by 10%. Target: 78% Actual: TBD 30f5b742-a89c-4371-87ce-13930da80acb Fiscal Stewardship Promote sound fiscal stewardship Goal_42491c0b-fa03-4f03-b29a-8a10fa2453ac 3 Department of Alcohol and Other Drug Abuse Services DAODAS receives significant funding from HHS and the agencies collaborate to discuss/design Medicaid service offerings. Associated Goal(s): 3.1.1; 3.2.1 Cost & Quality Control Cost, quantity, and quality of services provided to D&A clients. Department of Mental Health DMH is a major provider of behavioral health services for Medicaid beneficiaries. Associated Goal(s): 3.1.1; 3.2.1 Behavioral Health Services Access to and cost of behavioral health services Data data on the sponsored housing program for chronically mentally ill individuals. Department of Education Associated Goal(s): 3.1.1; 3.2.1 Cost & Quality Control Cost, quantity, and quality of services provided in school-based settings or for PreK-12 students. Intermediary SCDE has traditionally served as an intermediary between HHS and the school districts that provide Medicaid-funded services. Continuum of Care Associated Goal(s): 3.1.1; 3.2.1 Service Management Continuum manages services for children needing the most intensive behavioral health assistance; these services are often Medicaid-funded. Cost & Quality Control Cost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance. Lt. Governor's Office Associated Goal(s): 3.1.1; 3.2.1 Data Enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services. Collaboration The 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 Needs Associated Goal(s): 3.1.1; 3.2.1 Waivers DDSN administers certain waiver programs on behalf of HHS; DDSN is primarily financed through HHS. Financing Administrative costs, service delivery costs, time required to move individuals off of waiting lists and into services Department of Social Services Many Medicaid beneficiaries also receive some form of services through DSS (SNAP, TANF, foster care, etc.). Associated Goal(s): 3.1.1; 3.2.1 Collaboration The agencies collaborate on eligibility and to serve certain populations. Cost Control Cost/quantity of services authorized for and/or care coordinated for children in therapeutic foster care Metrics metrics 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 Carolina Associated Goal(s): 3.1.1; 3.2.1 Telemedicine Administration MUSC 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] Budget Develop reliable budget forecasts and mid-year correction mechanisms Objective_02e854cc-4285-4946-b88c-78df2000194b 1 Continuum of Care Associated Goal(s): 3.1.1; 3.2.1 Service Management Continuum manages services for children needing the most intensive behavioral health assistance; these services are often Medicaid-funded. Cost & Quality Control Cost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance. Medical University of South Carolina Associated Goal(s): 3.1.1; 3.2.1 Telemedicine Administration MUSC 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 Needs Associated Goal(s): 3.1.1; 3.2.1 Financing Administrative costs, service delivery costs, time required to move individuals off of waiting lists and into services Waivers DDSN administers certain waiver programs on behalf of HHS; DDSN is primarily financed through HHS. Department of Alcohol and Other Drug Abuse Services DAODAS receives significant funding from HHS and the agencies collaborate to discuss/design Medicaid service offerings. Associated Goal(s): 3.1.1; 3.2.1 Cost & Quality Control Cost, quantity, and quality of services provided to D&A clients. Department of Social Services Many Medicaid beneficiaries also receive some form of services through DSS (SNAP, TANF, foster care, etc.). Associated Goal(s): 3.1.1; 3.2.1 Cost Control Cost/quantity of services authorized for and/or care coordinated for children in therapeutic foster care Collaboration The agencies collaborate on eligibility and to serve certain populations. Metrics metrics tied to Medicaid administrative activities and DSS activities related to carrying out the Medicaid State Plan; capitation rates for foster children. Department of Mental Health DMH is a major provider of behavioral health services for Medicaid beneficiaries. Associated Goal(s): 3.1.1; 3.2.1 Data data on the sponsored housing program for chronically mentally ill individuals. Behavioral Health Services Access to and cost of behavioral health services Department of Education Associated Goal(s): 3.1.1; 3.2.1 Cost & Quality Control Cost, quantity, and quality of services provided in school-based settings or for PreK-12 students. Intermediary SCDE has traditionally served as an intermediary between HHS and the school districts that provide Medicaid-funded services. Lt. Governor's Office Associated Goal(s): 3.1.1; 3.2.1 Collaboration The agencies collaborate on enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long-term care or nursing facility services. Data Enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services. 1 General Fund Expenditures Percentage PerformanceIndicator_2e60cb5b-a5c4-4740-92ea-fc6a2e165173 Time 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 spending 2018-07-01 2 Base: <2% 2018-07-01 2019-06-30 0 Actual: TBD 2018-07-01 2019-06-30 3 Maintain General Fund expenditures within 3% of forecast. Target: <3% 771ad5f0-a6d9-4068-91d4-91a517e1d1d4 Healthcare Spending Control increases in healthcare spending Objective_bec40b63-b278-4048-92a8-d63b93ba0df8 2 [To be named] [To be named] 1 Cost Increases Percentage PerformanceIndicator_00a3578b-48fb-4627-8150-15b358bcc09f Time 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 spending 2018-07-01 2019-06-30 2.1 Keep per-member cost increases below national benchmarks. Base: PMPM Growth: 2.1% HC Cost Growth: 2.5% Target: Less than health care cost growth 2018-07-01 2019-06-30 0 Actual: TBD a81137be-c743-41d2-8248-faf039451610 Waste, Fraud & Abuse Prevent waste, fraud and abuse Objective_0f1f2399-25c3-4720-ada1-5ed34d552fe6 3 [To be named] [To be named] 1 Expenditures Analyzed Percentage PerformanceIndicator_53dca34f-877b-4c43-adc1-94bec4254363 Time 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 abuse 2018-07-01 86 Base: 86% 2018-07-01 2019-06-30 0 Actual: TBD 2018-07-01 2019-06-30 93 Increase the percentage of expenditures analyzed for third-party liability by 5%. Target: 90.3% 8a8fe0b0-c6f5-4d50-8fc3-0817db261264 Management Provide responsive and responsible management of health and human service programs Goal_faeb432e-3ab0-4905-933b-81d1f41ccf21 4 [To be named] [To be named] [To be named] [To be named] [To be named] [To be named] Provider Relations Ensure timely handling of provider relations Objective_240e8752-a945-48ea-b7d6-9c7f1b7792ac 1 [To be named] [To be named] 1 Applications Processed on Time Percentage PerformanceIndicator_fee65493-a944-4162-8d21-999802d51308 Time 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 relations 2018-07-01 100 Base: 100% 2018-07-01 2019-06-30 0 Actual: TBD 2018-07-01 2019-06-30 99 Process 99% of provider applications within 30 days. Target: 99 % 86111d9f-ac47-40bb-91a0-7c93101c19ee 1 Claims Processed on Time Percentage PerformanceIndicator_23c00ba7-4fa9-45c6-9de9-b3ee0d594905 Time 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 relations 2018-07-01 100 Base: 100% 2018-07-01 2019-06-30 0 Actual: TBD 2018-07-01 2019-06-30 99 Process 99% of electronic claims submissions within 14 days. Target: 99 % e85d4ccf-36e7-4d7e-acea-232325d88584 Workforce Engagement Develop and maintain a committed and engaged workforce Objective_aca05049-35e4-4028-963b-48ae5a38b366 2 [To be named] [To be named] 1 Engagement Score Percentage PerformanceIndicator_49d7b907-5ee1-400b-9ebf-ab4c2df0e1c3 Time 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 programs 2018-07-01 0 Base: 50% 2018-07-01 2019-06-30 52.5 Improve employee engagement scores by 5% Target: 52.5% 2018-07-01 2019-06-30 0 Actual: TBD a8ae086c-a48d-4e9a-bb36-fc5fd0311ef4 StrategyPlan_751f61ec-3982-4836-82b4-446f68643bea 2018-07-01 2019-06-30 2025-12-24 https://www.stratnavapp.com/StratML/Part2/751f61ec-3982-4836-82b4-446f68643bea/Styled Submitter_751f61ec-3982-4836-82b4-446f68643bea Owen Ambur