Clinical Efficiencies

The Clinical Efficiency (CE) performance measures dashboard tracks and evaluates the Managed Care Organizations’ (MCOs) success in reducing preventable, avoidable, and/or medically unnecessary utilization. The goal of the CE policy is to incentivize MCOs to direct resources and care support efforts to avoid these events and reduce associated utilization and costs. The CE measures evaluated are:

• Potentially Preventable Admissions (PPA).
• Potentially Preventable, Avoidable, and/or Medically Unnecessary Emergency Department Visits (PPED).
• Acute Inpatient (IP) 30-day readmissions (READ).

The reporting period for all measures will be 12 months, allowing for a six-month claims runout.