Accountability Report: Fiscal Year 2018-2019South Carolina Department of Health and Human ServicesSCDHHS_930ecff0-16e2-11e9-8cf9-f416226c4d73Joshua D. BakerAgency DirectorTo be a responsive and innovative organization that continuously improves the health of South Carolina._930ed1da-16e2-11e9-8cf9-f416226c4d73To purchase the most health for our citizens in need at the least possible cost for taxpayers._930ed2a2-16e2-11e9-8cf9-f416226c4d73MedicaidProvide better health outcomes for Medicaid beneficiaries_930ed356-16e2-11e9-8cf9-f416226c4d731Medicaid 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. PaymentsExpand the use of value-based payment methodologies_930ed414-16e2-11e9-8cf9-f416226c4d731.1Managed Care OrganizationsThe 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. Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs. Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs. Associated Goal(s): 1.1.1; 1.1.2; 3.1.1; 3.2.1 1.1.1 Provide at least 30% of managed care payment using a value-based approach Base: 32% Target: 30% Actual: TBD 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***************1.1.2 Increase the percentage of HEDIS withhold metrics at or above the 50th percentile by 2% annually Base: 92% Target: 94% Actual: TBD 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 methodologiesBirth OutcomesBuild upon the success of the Birth Outcomes Initiative_930ed54a-16e2-11e9-8cf9-f416226c4d731.2Department of Health and Environmental ControlDHEC is an important service provider and information source for Medicaid beneficiaries. Data used in program development and management (obesity, immunizations, etc.) Data used in program development and management (obesity, immunizations, etc.) Associated Goal(s): 1.2.1; 3.1.1; 3.2.1 1.2.1 Reduce the rate of low birth weight babies by 3% Base: 11% Target: 9.02% Actual: TBD 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 InitiativeMember ServicesProvide outstanding member services_930ed608-16e2-11e9-8cf9-f416226c4d732TechnologyUse new technologies to improve the member service experience_930ed6d0-16e2-11e9-8cf9-f416226c4d732.12.1.1 Increase the number of online applications by 10% Base: 3402700% Target: 37,430 Actual: TBD 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 experienceApplications & ReviewsImprove processing time and resolution rates for applications and reviews_930ed784-16e2-11e9-8cf9-f416226c4d732.22.2.1 Increase the rate of one-hour resolution for walk-in services by 10% Base: 71% Target: 78% Actual: TBD 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**************************2.2.2 Increase the rates of single-touch case resolutions for applications and reviews by 10% Base: 70% Target: 77% Actual: TBD 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 reviewsFiscal StewardshipPromote sound fiscal stewardship_930ed856-16e2-11e9-8cf9-f416226c4d733BudgetDevelop reliable budget forecasts and mid-year correction mechanisms_930ed950-16e2-11e9-8cf9-f416226c4d733.1Department of Disabilities and Special NeedsDDSN administers certain waiver programs on behalf of HHS; DDSN is primarily financed through HHS. Administrative costs, service delivery costs, time required to move individuals off of waiting lists and into services Administrative costs, service delivery costs, time required to move individuals off of waiting lists and into services Associated Goal(s): 3.1.1; 3.2.1Department of Mental HealthDMH is a major provider of behavioral health services for Medicaid beneficiaries. Access to and cost of behavioral health services; data on the sponsored housing program for chronically mentally ill individuals. Access to and cost of behavioral health services; data on the sponsored housing program for chronically mentally ill individuals. Associated Goal(s): 3.1.1; 3.2.1Department of EducationSCDE has traditionally served as an intermediary between HHS and the school districts that provide Medicaid-funded services. Cost, quantity, and quality of services provided in school-based settings or for PreK-12 students. Cost, quantity, and quality of services provided in school-based settings or for PreK-12 students. Associated Goal(s): 3.1.1; 3.2.1 Department of Social ServicesMany Medicaid beneficiaries also receive some form of services through DSS (SNAP, TANF, foster care, etc.). The agencies collaborate on eligibility and to serve certain populations. Cost/quantity of services authorized for and/or care coordinated for children in therapeutic foster care; metrics tied to Medicaid administrative activities and DSS activities related to carrying out the Medicaid State Plan; capitation rates for foster children. Cost/quantity of services authorized for and/or care coordinated for children in therapeutic foster care; metrics tied to Medicaid administrative activities and DSS activities related to carrying out the Medicaid State Plan; capitation rates for foster children. Associated Goal(s): 3.1.1; 3.2.1Lt. Governor's OfficeThe agencies collaborate on enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long-term care or nursing facility services. Enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services. Enrollment and eligibility data for elderly and vulnerable adults pursuing Medicaid eligibility to receive long term care or nursing facility services. Associated Goal(s): 3.1.1; 3.2.1Department of Alcohol and Other Drug Abuse ServicesDAODAS receives significant funding from HHS and the agencies collaborate to discuss/design Medicaid service offerings. Cost, quantity, and quality of services provided to D&A clients. Cost, quantity, and quality of services provided to D&A clients. Associated Goal(s): 3.1.1; 3.2.1Continuum of CareContinuum manages services for children needing the most intensive behavioral health assistance; these services are often Medicaid-funded. Cost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance. Cost, quantity, and quality of services provided to children needing the most intensive behavioral health assistance. Associated Goal(s): 3.1.1; 3.2.1Medical University of South CarolinaMUSC 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. Use of telemedicine treatments and services; cost of Graduate Medical Education/Supplemental Teaching Payments programs. Associated Goal(s): 3.1.1; 3.2.13.1.1 Maintain General Fund expenditures within 3% of forecast Base: <2% Target: <3% Actual: TBD 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 spendingHealthcare SpendingControl increases in healthcare spending_930eda0e-16e2-11e9-8cf9-f416226c4d733.23.2.1 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 Actual: TBD 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 spendingWaste, Fraud & AbusePrevent waste, fraud and abuse_930edae0-16e2-11e9-8cf9-f416226c4d733.33.3.1 Increase the percentage of expenditures analyzed for third-party liability by 5% Base: 86% Target: 90.3% Actual: TBD 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 abuseManagementProvide responsive and responsible management of health and human service programs_930edbd0-16e2-11e9-8cf9-f416226c4d734Provider RelationsEnsure timely handling of provider relations_930edca2-16e2-11e9-8cf9-f416226c4d734.14.1.1 Process 99% of provider applications within 30 days Base: 100% Target: 99+% Actual: TBD 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****************************4.1.2 Process 99% of electronic claims submissions within 14 days Base: 100% Target: 99+% Actual: TBD 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 relationsWorkforce EngagementDevelop and maintain a committed and engaged workforce_930edd7e-16e2-11e9-8cf9-f416226c4d734.24.2.1 Improve employee engagement scores by 5% Base: 50% Target: 52.5% Actual: TBD 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 programs2018-07-012019-06-302019-01-12https://www.scstatehouse.gov/reports/aar2018/L040.pdfOwenAmburOwen.Ambur@verizon.net