PACE Performance 2025 - FL

Overview

The FL PACE dashboard enables your organization to evaluate and monitor the performance of contracted metrics with FLBL for bonus eligibility. It offers a visual representation of key performance indicators (KPIs) and metrics, allowing you to track progress toward achieving predetermined goals.

The dashboard includes 8 KPIs within the following categories:

  • Patient Experience

  • Operations

  • Population Health / Quality

  • Access

Metrics Definitions

Provider Wellness: Response Rate

Population: Active Sanitas Providers

Performance Goal: 85%

Data Range: Sep 1 -30

Calculation: Same as last year

Notes: N/A

Provider Wellness: Joyful Workplace

Population: Active Sanitas Providers

Performance Goal: 40%

Data Range: Sep 1 -30

Calculation: Same as last year

Notes: N/A

Social Drivers of Health

Population 1: FLBL Fully Insured Commercial only

Performance Goal: Baseline

Data Range: Q3

Calculation:

  • Denominator: [Count of encounters with a positive response for: Z59.41 Food, Z59.811 Housing, and Z59.82 Transportation]

  • Numerator: [Count of encounters with social prescription issued]

Notes:

July 14–Aug 15: Only pilot results ( Lake Worth, Fort Lauderdale, and St. Cloud centers ) From Aug 18: All centers included Data to be disaggregated by: center, region, and month Additional Considerations for KPI calculation:

  1. Unique patients are considered for the overall indicator as well as for indicators by any data dimension (e.g., by facility or by patient need).

  2. Financial Rx is internal informational purposes only, not contractual so it should not be considered in KPI calculation

  3. Only the first Rx type for that patient each calendar year counts for the denominator/numerator for housing, transport and food only

  4. Numerator should only consider the Rx in the denominator combine Sanitas (SCL_RX_IN=1) ---OR--- Lucerna OH (Email/SMS)

Population 2: FLBL Fully Insured Commercial only

Performance Goal: Q3 Performance (see notes)

Data Range: Q4

Calculation:

  • Denominator: [Count of encounters with a positive response for: Z59.41 Food, Z59.811 Housing, and Z59.82 Transportation]

  • Numerator: [Count of encounters with social prescription issued]

Notes:

If Q3 performance is below the floor, Q4 max benchmark = floor (40%) If Q3 performance is between the floor and ceiling, Q4 max benchmark = Q3 performance + 5% (up to 85%) If Q3 performance is above the ceiling, Q4 max benchmark = ceiling (85%)

% Diabetes Management for Sub-Population (ADI 6–10)

Population: FLBL Fully Insured Commercial only

Performance Goal: 38%

Data Range: Jan - Dec

Calculation:

  • Numerator: # of members with initial HbA1c > 8.0 and ≥0.5 improvement in final test

  • Denominator: # of members without an initial HbA1c ≤ 8.0

Notes:

Eligibility Criterias: Diabetes diagnosis per CMS CCW logic (as of January) Reside in ADI 6–10 area (as of January) Listed on Sanitas' January 2025 roster Active for ≥6 consecutive months on 2025 roster Remain on roster ≥3 months after initial HbA1c test Members tested after Sept 30 are not excluded from this rule

Appointment Availability: New Centers

Population: New Centers

Performance Goal: 100%

Data Range: Jan - Dec

Calculation: Same as last year (Use Median)

Notes:

Number of new centers with appointment availability ≤ 5 days / new centers *100%

New Centers: Duclay Windy Hill Central Ocala Southwest Ocala Collier Blvd North Naples Cape Coral South Fort Myers North Port Venice

Appointment Availability: Existing Centers

Population: Existing Centers

Performance Goal: 59

Data Range: Jan - Dec

Calculation: Same as last year (Use Median)

Notes: Number of centers with appointment availability ≤ 5 days

For "existing centers" please add Central Broward, Pompano Beach, Palmetto Bay, Countryside, and Winter Haven.

NPS

Population: FLBL Fully Insured Commercial only

Performance Goal: 85.00

Data Range: Jan - Dec

Calculation: Same as last year

  • Numerator: Total NPS scores of survey responses from patients seen by the provider

  • Denominator: Total number of survey responses from patients seen

Notes: Must display two decimal places Should reflect the same values presented in the "NPS and Patient Experience Analytics" dashboard.

BeWell Engagement (Watch Metric)

Population: FLBL Fully Insured Commercial only

Performance Goal: 35%

Data Range: Jan - Dec

Calculation: Same as last year

  • Numerator: [Eligible Patients in the Denominator seen by BeWell who received Coordination of Care Management (CoCM) Services]

  • Denominator: [Eligible Denominator Patients] Eligible Patients are defined as having any one of the following diagnosis codes: (F.32, F.320, F.321, F.328, F.329, F.33, F.330, F.331, F.338, F.339, F.41, F.410, F.411, F.413, F.418, F.419, F.430, F.431, F.432, F.438, F.439)

Notes: Patients with one or more behavioral health diagnosis codes not explicitly listed above will be excluded from this measurement.

Measure
Measured Population
Performance Goal
Data Range
Calculation
Notes

Provider Wellness: Response Rate

Active Sanitas Providers

85%

Sep 1 - 30

Same as last year

Provider Wellness: Joyful Workplace

Active Sanitas Providers

40%

Sep 1 - 31

Same as last year

Social Drivers of Health

FLBL Fully Insured Commercial only

Baseline

Q3

Denominator: [Count of encounters with a positive response for: Z59.41 Food, Z59.811 Housing, and Z59.82 Transportation] Numerator: [Count of encounters with social prescription issued]

July 14–Aug 15: Only pilot results ( Lake Worth, Fort Lauderdale, and St. Cloud centers ) From Aug 18: All centers included Data to be disaggregated by: center, region, and month Additional Considerations for KPI calculation: 1. Unique patients are considered for the overall indicator as well as for indicators by any data dimension (e.g., by facility or by patient need). 2. Financial Rx is internal informational purposes only, not contractual so it should not be considered in KPI calculation 3. Only the first Rx type for that patient each calendar year counts for the denominator/numerator for housing, transport and food only 4. Numerator should only consider the Rx in the denominator combine Sanitas (SCL_RX_IN=1) ---OR--- Lucerna OH (Email/SMS)

FLBL Fully Insured Commercial only

Q3 Performance (see notes)

Q4

Denominator: [Count of encounters with a positive response for: Z59.41 Food, Z59.811 Housing, and Z59.82 Transportation] Numerator: [Count of encounters with social prescription issued]

If Q3 performance is below the floor, Q4 max benchmark = floor (40%) If Q3 performance is between the floor and ceiling, Q4 max benchmark = Q3 performance + 5% (up to 85%) If Q3 performance is above the ceiling, Q4 max benchmark = ceiling (85%)

% Diabetes Management for Sub-Population (ADI 6–10)

FLBL Fully Insured Commercial only

38%

Jan - Dec

Numerator: # of members with initial HbA1c > 8.0 and ≥0.5 improvement in final test Denominator: # of members without an initial HbA1c ≤ 8.0

Eligibility Criterias: Diabetes diagnosis per CMS CCW logic (as of January) Reside in ADI 6–10 area (as of January) Listed on Sanitas' January 2025 roster Active for ≥6 consecutive months on 2025 roster Remain on roster ≥3 months after initial HbA1c test Members tested after Sept 30 are not excluded from this rule

Appointment Availability: New Centers

New Centers

100%

Jan - Dec

Same as last year (Use Median)

# new centers with appointment availability ≤ 5 days / new centers *100% New Centers: Duclay Windy Hill Central Ocala Southwest Ocala Collier Blvd North Naples Cape Coral South Fort Myers North Port Venice

Appointment Availability: Existing Centers

Existing Centers

59

Jan - Dec

Same as last year (Use Mediam)

# appointment availability ≤ 5 days For "existing centers" please add Central Broward, Pompano Beach, Palmetto Bay, Countryside, and Winter Haven.

NPS

FLBL Fully Insured Commercial only

85.00

Jan - Dec

Same as last year

Must display two decimal places Should reflect the same values presented in the "NPS and Patient Experience Analytics" dashboard.

BeWell Engagement (Watch Metric)

FLBL Fully Insured Commercial only

35%

Jan - Dec

Numerator: [Eligible Patients in the Denominator seen by BeWell who received Coordination of Care Management (CoCM) Services] Denominator: [Eligible Denominator Patients] Eligible Patients are defined as having any one of the following diagnosis codes: (F.32, F.320, F.321, F.328, F.329, F.33, F.330, F.331, F.338, F.339, F.41, F.410, F.411, F.413, F.418, F.419, F.430, F.431, F.432, F.438, F.439)

Patients with one or more behavioral health diagnosis codes not explicitly listed above will be excluded from this measurement.

Tabs Overview

Executive Summary

Contains a single KPI followed by a chart or seconardy KPI for each of the tabs listed below.

Provider Wellness Survey

Contains metrics to be utilized for the annual provider wellness survey to assess how providers are feeling about the workplace. There are two sub-tabs associated with the Wellness Survey: Analysis and Response Tracking. The details below are specifically for the Analysis view

Metrics included are:

  • Mini Z: Joyful Workplace

  • Subscale 1: Supportive Work Environment

  • Subscale 2: Reasonable Pace & EMR Stress

  • Burnout Median

  • Response Rate

  • Burnout Responses

  • Response Trend

The bottom of the tab contains a table that summarizes responses by the following dimentsions:

  • Practice Type

  • Provider Type

  • Region

  • County

  • Facility

SDOH

Contains metrics related to social determinants of health. There are two sub-tabs associated with this view: Production Results and Pilot Results.

Metrics included in Production Results are:

  • Numerator, Denominator, and SDOH KPI %

  • Eligible Encounters by Visit Type

  • Performance by Visit Type

  • Performance Details by Visit Type

  • Eligible Encounters by Facility

  • KPI by Facility

  • Performance Details by Facility

  • Eligible Encounters by Date

  • Detailed Data

Metrics included in Pilot Results are:

  • Numerator, Denominator, and SDOH KPI %

  • Eligible Encounters by Visit Type

  • Performance by Visit Type

  • Performance Details by Visit Type

  • Eligible Encounters by Facility

  • Performance by Facility

  • Performance Details by Facility and Date

  • Detailed Data

Diabetes

Contains KPIs and data tables about the diabetes work being done. Results are broken down by:

  • Sanitas Results

  • Florida Blue Results

  • Combined Results

Metrics included are:

  • Members

  • Improvement Rate

  • Regional Results

  • Facility Results

  • Provider Results

  • Performance Details

Appt Availability

Contains metrics that show medianl/average wait times as wells as trended results over time. There are three sub-tabs: New Centers, Existing Centers, and Raw Data.

Metrics included are:

  • Performance

  • Performance by Facility

  • Performance Trend by Region

Patient Experience

Metrics included are:

  • NPS

  • NPS by Language

  • NPS Trend

  • NPS by Region

  • NPS by Service Line

  • NPS by Facility

  • NPS by Provider

Care Continuity

Metrics included are:

  • Care Team Continuity %

  • Care Team Continuity Trend

  • Care Team Continuity by Facility and Date

  • Care Team Continuity by Provider and Date

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