Stakeholder Metrics

Community Care produces quality, member demographic, and utilization reports for contract stakeholders. Please find links to downloadable reports below. A glossary of commonly used health care terms on this page can be found here.

Metrics currently available for:

Allegheny County (as of January 1, 2024)

Quality Measures

The Quality Measures provide rates for 2 areas of focus once a HealthChoices (HC) member is discharged from Inpatient Mental Health Hospitalization. These include:

7 & 30 Day Follow Up Visits After Inpatient Mental Health Hospitalization: Based on HEDIS and Pennsylvania Specific logic: These measures indicate the percentage of discharges for HC members six years of age and older who were hospitalized for treatment of mental health disorders and who had a follow-up visit with a mental health practitioner or peer support.
30 Day Readmission Rates Post Inpatient Mental Health Hospitalization: This performance measure assesses the percentage of acute inpatient stays for psychiatric care with subsequent readmission to inpatient acute psychiatric care within thirty days of the initial inpatient acute psychiatric discharge.

Integrated Care Plan (ICP) Measures

ICP measures focus on HealthChoices HC Members with a Severe Mental Illness (SMI) diagnosis. The program is a comprehensive view of members, ages 18 and over, from Physical and Behavioral Health treatment. The measure specifications are provided by the state and based on HEDIS standards. These areas include:

BH-PH Inpatient 30 Day Readmission Rate for Members with Serious Mental Illness: This measure determines the 30-day acute inpatient readmission rate for adult members with a history of SMI.
Diabetes Care for People with Serious Mental Illness Hemoglobin A1c (HbA1c) Poor Control (>9.0%): The measure is designed to assess rates at which HC members between 18 – 75 years of age with SPMI and diabetes (type 1 or type 2) whose most recent hemoglobin A1c (HbA1c) in the measurement year is in poor control (>9.0%).
Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia: The ICP-Lipid Monitoring measure is designed to assess rates at which HC members with an SMI and cardiovascular disease receive an LDL-C test (lipid panel) during the measurement year.
Diabetes Screening for People with Schizophrenia or Bipolar Disorder who are using Antipsychotic Medications: The measure is to assess rates at which HC member between 18-64 years of age with an SMI who were dispensed antipsychotic medication were screened for diabetes during the measurement year.

Member Demographics and Utilization

Membership Analysis and Summary: A comprehensive view of the current Allegheny HealthChoices Membership and Demographics.
Behavioral Health Service Utilization Trends: These graphs present the percentage of Allegheny HealthChoices members that have received at least one Behavioral Health or Drug and Alcohol Service during the measurement period. Both members that received an authorization for services and members that had a paid claim are reported in the data.

Measures Related to Substance Use Disorders (SUD)

Prevention, Early Detection, Treatment and Recovery (PEDTAR) for Substance Use disorders. PEDTAR aim’s to significantly slow (and eventually stop) the growth of SUD prevalence among Health Choices members, while improving outcomes for those individuals with SUD. Three key performance indicators associated with the project are described below.

HEDIS Follow-Up After High-Intensity Care for Substance Use Disorder (HEDIS FUI): Assesses the percentage of inpatient, residential treatment and detoxification visits or discharges for a diagnosis of substance use disorder (SUD) among patients 13 years of age and older that resulted in follow-up care for a diagnosis of SUD within 7 and 30 days.
Mental Health-Related Avoidable Readmissions (MHR): The percentage of mental health (MH) related avoidable readmissions occurring within 30 days of a discharge that is either detox, inpatient rehab or residential services with an Alcohol and Other Drug (AOD) disorder primary diagnosis, among members 13 years of age and older.
Substance Use Disorder-Related Avoidable Readmissions (SAR): The percentage of substance use disorder (SA) related avoidable readmissions occurring within 30 days of a discharge that is either detox, inpatient rehab or residential services with an Alcohol and Other Drug (AOD) disorder primary diagnosis, among members 13 years of age and older.

MAT POD Measure: This measure is based on adapted HEDIS Pharmacotherapy (POD) specifications. The report measures the percentage of Allegheny members with a NEW OUD diagnosis and MAT events for 180 or more days among members 16 years of age and older.

Rate for Retention: Eligible Numerator Events (180+ Days of Eligible MAT) / Eligible Denominator Events (Qualifying Events from the eligible member criteria)

Medication Assisted Treatment Measure for HealthChoices (HC) Members with Opioid(OUD) or Alcohol (AUD) Use Disorder

Tracks access to medication assisted treatment for HC Enrolled Adults (Age >= 18). The denominator is calculated as distinct members who had a paid claim with an AUD/OUD diagnosis for each quarter. Numerator is calculated as distinct members with a pharmacy claim/service* in the same quarter with at least one AUD/OUD diagnosis.

*AUD: Antabuse, Campral or Naltrexone prescription
*OUD: Buprenorphine or Naltrexone prescription or Methadone or Buprenorphine service

Provider Network

Network Provider Service Locations: A map of the current service locations from Allegheny's provider network.