Hospital Transformation Program

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.

Valley View Hospital will focus on 6 statewide measures, 1 statewide priority, and 3 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 PIdistributiongroup@vvh.org

Reducing Avoidable Hospitalization Utilization

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.

RAH4 – Percentage of Patients with Ischemic Stroke who are Discharged on Statin Medication (eCQM)

This measure captures the proportion of ischemic stroke patients who are prescribed a statin medication at hospital discharge.

Core Populations

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 done within 12 months of the admission or at the time of visit, 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.
Social needs screening should include at a minimum, five core domains consisting of housing instability; food insecurity

CP6 – Screening and Referral for Perinatal and Post-Partum Depression and Anxiety and Notification of Positive Screens to the RAE

Percentage of pregnant Medicaid patients screened at any hospital encounter identified through an IP or OP hospital claim for perinatal and post-partum anxiety and depression during pregnancy or the postpartum period (60 days) with the RAE notified within one business day if the screen is positive.

Behavioral Health/Substance Use Disorder

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

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 and notification process with or to the RAE within one business day. The Substance Abuse and Mental Health Services Administration defines SUD as alcoholism and drug dependence and addiction or the use of alcohol or drugs that is compulsive or dangerous.

SW-BH3 – Using Alternatives to Opioids (ALTO’s) in Hospital EDs: 1) Decrease use of opioids 2) Increase use of ALTO’s

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. 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.

Clinical and Operational Efficiencies

SW-COE1 – Hospital Index

A measure of avoidable care across procedural episodes. A hospital’s index score will be compared to a baseline index score.

COE1 – Increase the successful transmission of a summary of care record to a patient’s primary care physician (PCP) or other healthcare professional within one business day of discharge from an inpatient facility to home

Successful transmission of a summary of care record, as described in the intervention, to a Medicaid patient’s PCP or other healthcare professional within one business day of discharge from an inpatient facility to home.

Population Health/Total Cost of Care

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

Severity Adjusted LOS compared to 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.

Statewide Priorities

SP-PH2 – Creation of Dual Track ED

A separate process for lower acuity patients presenting to the emergency room department with less serious conditions who can be treated and released more quickly.