QIM PROPOSAL PROCESS

Drafted by Leslie Neugebauer and Lindsey Hopper on January 5, 2016

Adopted: January 14, 2016

Purpose and Source of Funding

The purpose of this document is to create a process to deploy QIM dollars received by the CCO in 2015 based on QIM performance in 2014. The CCO received $3.27M, and $375K has been allocated to the Central Oregon access study. As a result, approximately $2.9M remains to be deployed for best and highest use in Central Oregon.

This process may be replicated throughout 2016 to deploy QIM funds disbursed to the CCO in 2016 based on QIM performance in 2015.

Submission Requirements

  1. The CCO request proposals that address the following present-state conditions:
  • Declining CAHPS scores
  • Low member engagement in preventive services
  • Stagnant performance on the following QIMs:
  • AWCVs
  • SBIRT
  • ECU
  • Addressing QIMs we’ve been historically successful with, but where the performance bar keeps rising with each year
  • Addressing new or revised QIMs
  • Member no-shows for covered services
  • Absence of a robust, regional HIE
  • Technology challenges that prevent continued progress on the CCO Technology Plan
  1. Proposals must include metrics to evaluate impact, as well as mechanisms for tracking metrics and, if applicable, an evaluation plan.
  1. Proposals should request funding for interventions and metrics tracking/evaluation.
  1. Submitters must use the template for proposals that will include an Analytics tool.
  1. Outreach to PacificSource’s Analytics team, during proposal development, is encouraged.
  1. Letters of support are optional but may be valuable. Submitters should consider whether CAC, PEP, or Ops review and endorsement is appropriate and valuable, depending on the proposal.

Submission Process

  1. Submitters will transmit proposals to CCO team will review and ask clarifying questions as needed.
  2. For proposals that request less than $50,000:
  • CCO staff may use discretion in approving such proposals (similar to the way the 2013 QIM funds are currently being managed).
  • If PacificSource is submitting the proposal and would be a recipient of funds, COHC staff may use discretion in approving such proposals.
  1. For proposals that request more than $50,000:
  • CCO and COHC staff will jointly review.
  • The group will form a recommendation to fund or not fund.

Evaluation and Design

Proposals that are recommended for funding or approved for funding will be submitted to the PacificSource Analytics team for formal review of proposal design and evaluation. The Analytics team may make recommendations or edits as appropriate. Once the proposal design and evaluation have been solidified, the proposal may be funded, based on the decision tree set forth below.

Award Decisions

For proposals that request $400,000 or more:

  • The Finance Committee will submit a recommendation to the COHC to fund or not fund the proposal
  • The COHC will determine whether to fund the proposal.

For proposals that request $150,000 or more but less than $400,000:

  • The Finance Committee will determine whether to fund the proposal.

For proposals that request more than $50,000 but less than $150,000:

  • CCO and COHC staff will determine whether to fund the proposal.