• The target trendline in the graph above represents an accepted national benchmark percentile for Medicaid programs across the country. The value graphed historically was the national 50^th percentile for comparison purposes. In 2020 (for measurement year 2019) we modified the value shown to demonstrate a target based on our actual performance.  For this measure, the target is the 10^th national percentile.
• Please note that a lower rate is better for this measure.
• Please note that we are unable to attain the 2019 50th percentile national benchmark due to NCQA requirements.  We re-used the 2018 benchmark for 2019.
• The annual reported rate captures activity during the previous calendar year. 
• This is a Healthcare Effectiveness & Data Information Set (HEDIS) administrative measure.
• This rate is reported as the number of visits per 1000 member months.
• DVHA’s rates only include Medicaid Primary beneficiaries in HEDIS administrative measures.

This is a measure of ambulatory care emergency department (ED) visits. Ambulatory care is medical care provided on an out-patient basis, meaning there isn't the need for a prolonged stay, or admission, to the medical facility. For this measure, we count each visit to an ED that does not result in an inpatient encounter once, regardless of the intensity or duration of the visit. We count multiple visits to the ED on the same date of service as one visit. This measure does not include mental health or chemical dependency services.

A lower rate is generally better for this measure as an indication that the EDs are being used appropriately for emergency care. The drop in our rate in 2021 (for measurement year 2020) is likely attributable to the COVID-19 pandemic.

This measure can be broken down by many different age groups, but the rate reported here is the rate for all age groups combined.

The MCE Quality Committee decided that in order to better demonstrate the breadth of Medicaid services covered under the Global Committment waiver, DVHA would break out  performance measure data into smaller sub-populations when possible.  In 2017, the calendar year 2016 AMB-ED performance measure was the first to be broken out. 

• Rates in the chart below are based on the Vermont Medicaid Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid and dual Medicaid and Medicare enrollees.  Dually enrolled members are included in these rates because the sub-population break outs include high proportions of members who qualify for both Medicaid and Medicare.
• Populations identified by enrollment or services in state specific special programs:
  • Developmental Disabilities Services (DDS), one or more service with a DDS state service code 2703.
  • Children with Severe Emotional Disturbance (Child SED), represented by recipients with one or more non-crisis service by a Children's Mental Health services provider including: 1009765, 1009781, 1009758, 1009760, 1009784, 1009767, 1009768, 1009763, 1009814, 1009756, 1004136, 1007095, 1009764, 1009782, 1009759, 1009761, 1009783, 1009766, 009769, 1009762, 1009815, 1009757, 1009831.
  • Choices for Care (CFC), represented by eligibility for recipient placements between '010' and '030'.
  • Traumatic Brain Injury Program (TBI), one or more services with a TBI state service code 2713.
  • Community Rehabilitation and Treatment Programs for adults with severe and persistent mental illness, one or more services with a CRT state service code 916.

Last updated:  September 2021