Kentucky plans offered financial reward for meeting health outcome measures

As part of Kentucky’s Medicaid managed care initiative, called the Partnership Program, Kentucky established a series of seven health care outcomes the plans must monitor in the first and second years. In the third year, plans are expected to meet specific outcome goals.

Measures address normal body weight for both adults and children; reduced incidence of anemia and dental caries in children; reduced incidence of hypertension and depression in adults; normal glucose and hemoglobin levels in all members ; and normal growth and development in children.

Some of the outcome goals are aggressive. For example, the expectation in year two is that 40% of a plan’s population is screened for dental caries by age 3, and that 80% of those screened will be free of caries by the third year of the program. Similarly, a plan must show that 80% of members who receive a new prescription for an antidepressant are "personally seen" to evaluate their response to the medication between two and eight weeks from the date of the prescription.

In addition, plans can receive a bonus equal to 1% of the capitation payment for four outcome measures of their choice. From among 10 options, plans can choose to pursue health promotion measures such as ensuring appropriate birthweights, prenatal care, and immunizations.

Kentucky also measures some more unusual outcomes, including the goals that 25% of infants receive breast milk during their first six months of life, and that 80% of children under age 6 receive fluoride supplements if their water supply has less than .6 parts per million.

Other goals are to provide counseling about unintended pregnancies to 75% of women at risk of pregnancy, and to counsel 75% of members ages 9 to 21 about the risk of alcohol and drug use, sexual activity, and safety belt use.