Data in action

Supporting KCICN Provider Performance Through a Pay-for-Performance (P4P) model

In January 2019, the King County Integrated Care Network (KCICN) was established as an innovative model for providing behavioral health services to Medicaid-eligible residents with behavioral health conditions including serious mental illness and substance use disorders. In partnership with community-based agencies, the Behavioral Health and Recovery Division (BHRD) ensures that Medicaid patients can access behavioral health treatment and comprehensive care regardless of which managed care plan they are enrolled in for Medicaid benefits.

One part of the payment structure the KCICN employs is a pay-for-performance (P4P) program, wherein providers earn a financial incentive when they achieve and maintain best practices and high-quality care. Performance is measured through metrics in three key domains: basic business, clinical quality, and specialty metrics. The metrics of focus in the P4P is dependent on the network’s priorities at that time. Stronger provider performance on these metrics yields a higher P4P payment each quarter.

To summarize and disseminate provider performance on each metric, DCHS maintains a KCICN Performance Dashboard. The dashboard details provider-specific performance on each metric, as well as a network-level summary. This allows providers to understand not only their own performance (and corresponding P4P incentive payout), but also gives an indication of how the network is performing as a whole.

Actions resulted in:

• Increased transparency at the provider and network levels on quality and access to behavioral health services
• Opportunity for providers to increase their P4P payment by knowing which metrics need focused attention
• Evidence for the KCICN on whether the network is meeting some of its intended objectives to deliver high quality and integrated behavioral health care

Next steps:

• Add or modify performance metrics to align with community need and BHRD priorities
• Give providers the ability to run their own metric reports, so they can view current status on performance metrics rather than waiting for each quarterly report
• Continue to build data visualizations that communicate provider and network-level trends on quality of care

Understanding the Reach of King County School-to-Work

The King County School-to-Work (S2W) program works with teachers, school districts, and families to connect students with developmental disabilities to employment services while they are still in high school transition programs. S2W in King County has many outreach activities throughout the year to support enrollment in the program and build relationships with schools and families. In an effort to continuously improve outreach activities, King County staff conducted an analysis of who the program is reaching, looking at data by school district, support needs, and race and ethnicity of students. Staff used what they learned through this analysis, and relationships with community partners and families, to identify next steps that aim to improve outreach efforts and improve equitable access to the S2W program across King County.

Actions resulted in: 

• Opportunities for King County staff to reflect on what we are learning through our data and relationships with community partners and families
• A deeper understanding of areas where more information and relationship building is necessary to understand what may be impacting access and reach of the S2W program
• Incorporation of learnings into the development of ongoing outreach activities to improve equitable access to S2W programming across King County

Next steps:

• Use data to inform conversations with teachers and school district partners about how we can identify students earlier and better coordinate services
• Work with schools to improve approaches for students who need more support
• Build and strengthen relationships with Black, Indigenous, and People of Color (BIPOC) communities and community leaders to develop outreach plans that address the unique needs of King County’s diverse communities
• Support employment service providers with training and technical assistance to grow our language access supports, like translation and interpretation

Utilizing performance data for collective accountability among youth service providers

Stopping the School to Prison Pipeline (SSPP) helps create school-to-life success pathways for 12 to 24-year-old young people and their families involved with, or most likely to be pushed into, the legal system. Since its inception, the SSPP investment strategy has hosted monthly meetings for community-based providers to gather and check-in about their work. These meetings provided an opportune space to implement a community-engaged approach to performance measurement planning and improvement practices.

After the renewal of the Best Starts for Kids levy in 2022, King County SSPP staff and provider agencies collaborated to create a shared performance measurement framework and a performance data dashboard. The dashboard allows providers to see quarterly breakdowns of each other’s performance trends in relation to improved education, career, or employment, and other cohort identified outcomes. Providers have noted that the dashboard serves as an accountability tool that allows them to assess their own performance in relation to peer organizations doing similar work.

Actions resulted in: 

• Collective performance accountability among provider agencies
• Culture of collaboration and collective learning

Next steps: 

Development of a learning agenda based on quarterly performance update meetings to support continuous quality improvement in participant engagement and retention