Enrollment Data

The MSPB Hospital measure evaluates hospitals’ risk-adjusted episode costs relative to the risk-adjusted episode costs of the national median hospital. Specifically, the MSPB Hospital measure assesses the cost to Medicare for Part A and Part B services performed by hospitals and other healthcare providers during an MSPB Hospital episode, which is comprised of the periods 3-days prior to, during, and 30-days following a patient’s hospital stay. The MSPB Hospital measure is not condition specific and uses standardized prices when measuring costs.

The proportion of admissions to an institutional facility (e.g., nursing facility, intermediate care facility for individuals with intellectual disabilities [ICF/IID]) for managed long-term services and support (MLTSS) plan enrollees that result in successful discharge to the community (community residence for 60 or more days) within 100 days of admission. This measure is reported as an observed rate and a risk-adjusted rate.

This measure reports the percentage of a provider’s patients who were Medicaid beneficiaries ages 18 to 64 with an OUD diagnosis who filled a prescription for, or were administered or ordered, a FDA-approved medication to treat OUD within 30 days of the first attributable OUD treatment encounter with that provider.

Rate of risk-standardized acute, unplanned hospital admissions among Medicare fee-for-service (FFS) beneficiaries 65 years and older with diabetes who are assigned to an Accountable Care Organization (ACO).

Rate of risk-standardized acute, unplanned hospital admissions among Medicare fee-for-service (FFS) beneficiaries 65 years and older with heart failure who are assigned to an Accountable Care Organization (ACO).

Rate of risk-standardized acute, unplanned hospital admissions among Medicare fee-for-service
(FFS) beneficiaries 65 years and older with multiple chronic conditions (MCCs) who are assigned to an Accountable Care Organization (ACO).

The Total Per Capita Cost (TPCC) measure assesses the overall cost of care delivered to a beneficiary with a focus on the primary care they receive from their provider(s). The TPCC measure score is a clinician’s average risk-adjusted and specialty-adjusted cost across all beneficiary months attributed to the clinician during a one year performance period.