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Target Population FAQs

1. How do hospitals determine their target population?
The Environmental Scan, past payment and claims data should be evaluated to identify those persons eligible and intended for inclusion in the Healthy Outcomes Plan. The criteria for high utilizers is five or more visits in a 12-month period and one or more reccomended targeted conditions as defined in the Healthy Outcomes Plan Guidelines. The size of a Healthy Outcomes Plan's population must be determined using the Targeted Population Table.

2. Is the Target Population Table for zip codes or hospitals?
Hospitals.

3. What constitutes target population contact in the first 60 days and what is the acceptable frequency of contact?
A provider should make five reasonable attempts to contact the targeted individual. A reasonable attempt may include a combination of the following contact methods:  targeted individual accesses or utilizes your health care system, phone call, mail, email, home visit and any other method.

If the targeted individual is not reached, a new individual should be added to the targeted population list. For the first 90 days an individual who was unable to be located should not be dropped from the list.

4. If an individual is currently enrolled in Medicaid Family Planning, can they also participate in the HOP?
Yes. Individuals enrolled in Family Planning are considered underinsured and may be included in the HOP program.

5. The HOP Guidelines state that 2013 HOP participants should receive another health affordability screening in the first quarter of 2014. Is this still true?
No. Hospitals and providers do not have to re-screen HOP participants in ffirst quarter 2014. The guidelines were published when there was still uncertainty with Affordable Care Act implementation and operationalization.

6. Can you explain the Hospital Index Score?
The facility index score is the individual quintile rankings for each hospital. It consists of the percent of the total adult population included in Adult Cluster Hotspot Areas, Adult High Disease Prevalence Areas, and Palmetto SADI High Deprivation Areas with the quintile rankings of three different hospital utilization statistics (Percent of Emergency Department Discharges that are Uninsured, Rate of ED Discharges per 1,000 Uninsured, and Rate of Hospitalization per 1,000 Uninsured) for the county of the individual hospital. The facility index score rankings takes into consideration chronic disease, uninsured population, and social determinants variables. It is not the only variables associated with the final crafting of the panel size or in the determination of the distribution of the five million dollars.

Final Index Score Formula: ZCTA Adult Hotspot Quintile + High Disease Prevalence Area Quintile + SADI High Deprivation Area Quintile + Percent of ED Discharges that are Uninsured Quintile + Rate of ED Discharges per 1,000 Uninsured Quintile + Rate of Hospitalization per 1,000 Uninsured Quintile.

Metadata included for Index Score: The final score for each hospital was derived by summing indicator-specific sub-scores for the facility (i.e., the final score is an additive measure). The measures added are the following: ZCTA Cluster Hotspot - Quintile, High Disease Prevalence Area - Quintile, SADI High Deprivation Area - Quintile, Percent of ED Discharges that are Uninsured - Quintile, Rate of ED Discharges per 1,000 Uninsured - Quintile, and Rate of Hospitalization per 1,000 Uninsured - Quintile. The maximum possible score is 6.0; the minimum possible score is 1.2.

Metadata included for “ZCTA Cluster Hotspot” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the estimated proportion of the county adult population residing in an adult Hot Spot ZCTA cluster.*, **
  • *Quintile scores reflect county (service area) population proportion values rank-ordered from smallest to largest. Quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.4), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).
  • **In the adult disease hot spot county value range, all counties in the lowest two quintiles had no adult population in a hot spot ZCTA cluster. For this measure, quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.2), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).

This information is included with the environmental scan. The source for each of those indicators are the following:

1. Metadata included for “High Disease Prevalence Area” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the estimated proportion of the county adult population residing in a state catchment-specific adult high disease prevalence ZCTA.*
  • *Quintile scores reflect county (service area) population proportion values rank-ordered from smallest to largest. Quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.4), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).

2. Metadata included for “SADI High Deprivation Area” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the estimated proportion of the county adult population residing in a Palmetto SADI high socioeconomic deprivation area.*
  • *Quintile scores reflect county (service area) population proportion values rank-ordered from smallest to largest. Quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.4), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).

3. Metadata included for “Percent of ED Discharges that are Uninsured” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the percentage of ED discharges that are uninsured for that county.

4. Metadata included for “Rate of ED Discharged per 1,000 Uninsured” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the rate of ED discharges per 1,000 uninsured persons ages 0-64 for that county.*
  • *Quintile scores reflect county (service area) population proportion values rank-ordered from smallest to largest. Quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.4), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).

5. Metadata included for “Rate of Hospitalization per 1,000 Uninsured” Quintile:

  • Hospital scores reflect the ordered quintile ranking of the county of location (service), based on the rate of Inpatient Hospitalizations per 1,000 uninsured persons ages 0-64 for that county.*
  • *Quintile scores reflect county (service area) population proportion values rank-ordered from smallest to largest. Quintiles were scored as follows: Lowest Quintile (0.2), Second Quintile (0.4), Third Quintile (0.6), Fourth Quintile (0.8), Highest Quintile (1.0).
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