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Health Equity Measurement

Research focused on health equity measurement

Oregon Incentive Measures

The following table provides information from the 2021 CCO (Coordinated Care Organization) Incentive Measures, as decided by the Metrics Scoring Committee, July 17, 2020.

2021 CCO Incentive Measures
# Measure Measure Description Measure Steward Data Source* Population Characteristics Sector
Patient Population Sex
Dental Health
Behavioral Health
Primary Care
Specialty Physical Health**
Public Health
Prevention/Early Detection - Physical Health Conditions
1 Childhood Immunization Status (Combo 2) Percentage of children that turned 2 years old during the measurement year and had the Dtap, IPV, MMR, HiB, HepB, and VZV vaccines by their second birthday NCQA Claims/ Clinical Data Children All     Y     Y
2 Immunizations for Adolescents (Combo 2) Percentage of adolescents that turned 13 years old during the measurement year and had the meningococcal, Tdap, and HPV vaccines by their 13th birthday NCQA Claims/ Clinical Data Adolescent All     Y     Y
3 Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life (kindergarten readiness) Percentage of children ages 3 to 6 that had one or more well-child visits with a PCP during the measurement year NCQA Claims/ Clinical Data Children All     Y      
4 Prenatal & Postpartum Care - Postpartum Care Percentage of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year that had a postpartum visit on or between 21 and 56 days after delivery. NCQA Claims/ Clinical Data Adolescent, Adult, Older Adult Female     Y     Y
Prevention/Early Detection - Mental Health Conditions
5 Screening for Depression and Follow-Up Plan Percentage of patients aged 12 years and older screened for depression on the date of the encounter or up to 14 days prior to the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter. CMS Claims/ Clinical Data (eCQM measure) Adolescent, Adult, Older Adult All     Y      
Prevention/Early Detection - Substance Use Disorder (SUD) Conditions
6 Cigarette Smoking Prevalence Percentage of Medicaid members (ages 13 and older) who currently smoke cigarettes or use other tobacco products. OHA Clinical Data Adolescent, Adult, Older Adult All     Y     Y
7 Alcohol and Drug Misuse: Screening, Brief Intervention and Referral for Treatment (SBIRT) Percentage of patients ages 12 years and older who received an age-appropriate screening and, of those with a positive full screen, percentage who received a brief intervention or referral to treatment. OHA Clinical Data Adolescent, Adult, Older Adult All     Y      
Prevention/Early Detection - Oral Health Conditions
8 Members Receiving Preventive Dental Services, ages 1-5 (kindergarten readiness) and 6-14 Percentage of enrolled children ages 1-5 (kindergarten readiness) and 6-14 who received a preventive dental service during the measurement year OHA Claims Children, Adolescent All Y          
9 Oral Evaluation for Adults with Diabetes Percentage of adult CCO members identified as having diabetes who received at least one dental service within the reporting year OHA (modified from DQA/NCQA) Claims Adult, Older Adult Adults Y          
Prevention/Early Detection - All Conditions
10 Mental and Physical Health and Oral Health Assessment Within 60 Days for Children in DHS Custody Percentage of children ages 0-17 who received a physical health assessment, children ages 1-17 who received a dental health assessment, and children ages 4-17 who received a mental health assessment within 60 days of the state notifying CCOs that the children were placed into custody with the Department of Human Services (foster care) OHA Claims/ Social Service Data Children, Adolescent All Y Y Y      
Chronic Disease and Special Health Needs - Physical Health Conditions
11 Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period NCQA Claims/ Clinical Data (eCQM measure) Adult, Older Adult All     Y      
Chronic Disease and Special Health Needs - Substance Use Disorder (SUD) Conditions
12 Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment Percentage of adolescent and adult patients with a new episode of alcohol or other drug (AOD) dependence who (1) initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and (2) who initiated treatment and who had two or more additional services with a diagnosis of AOD within 34 days of the initiation
*Note Metrics & Scoring Committee may choose to limit measure to adults for calculations against incentive measure benchmark; this will be noted in specifications.
NCQA Claims Adolescent, Adult, Older Adult All   Y Y   Y  
Acute, Episodic and Procedural Care (Includes Maternity and Hospital)
13 Disparity Measure: Emergency Department Utilization among Members with Mental Illness Number of ED visits per 1,000 member months for adult members enrolled within the organization who are identified as having experienced mental illness Homegrown CCO Claims Adult, Older Adult All   Y Y   Y  
14 *NEW* Meaningful language access to culturally responsive health care services** The proportion of visits with spoken and sign language interpreter needs that were provided with OHA qualified or certified interpreter services. OHA Plan Reporting Children, Adolescent, Adult, Older Adult All Y Y Y Y Y  


* Clinical data includes electronic health records, registry data, and paper medical records. Claims/clinical data includes measures that require claims and clinical data, and measures that require claims or claims and clinical data. eCQM measures are indicated using italic font.
^ Denotes measure included in Challenge Pool
** Measure will be assessed for operational feasibility, reliability, validity and impact at 18 and 36 months following implementation by a state-funded health plan (CCOs, OEBB, PEBB, Oregon Health Insurance Ex.).

Measure Steward Abbreviations

AHRQ: Agency for Healthcare Research and Quality
AMA-PCPI: American Medical Association-convened Physician Consortium for Performance Improvement
CMS: Centers for Medicare & Medicaid Services
DQA: Dental Quality Alliance
MNCM: Minnesota Community Measurement
NCQA: National Committee for Quality Assurance
OHA: Oregon Health Authority
OHSU: Oregon Health & Science University
PQA: Pharmacy Quality Alliance
TJC: The Joint Commission

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