August 27 th , 2018 1 Agenda Welcome, introductions, meeting goals - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP August 27 th , 2018 1

Agenda • Welcome, introductions, meeting goals and agenda overview • Reflections from July meeting • Where we’re going in September and October • Update on stakeholder input survey and next steps • Public comment (1:20 PM) • Review and assess mental health utilization metric • “New” metric concepts • Summary of all “ready” and “near ready” metrics assessed • Reflections and feedback • HAKR Team process to develop proposals for feedback at September meeting • Next steps 2

Timeline and Work Plan August October September November • Conclude review • Review • Review draft • Present final and assessment proposal(s) for report with recommendations of “near ready” potential measure workgroup to Metrics and metrics recommendations recommendations Scoring with a phased Committee • Document • Discuss and approach interest in “new” incorporate • Begin to discuss metrics stakeholder input components of • Overview of all • Build consensus glide path metrics “ready” and “near on final ready” metrics recommendations assessed 3

Stakeholder Input About Our Work 4

Stakeholder Input on Workgroup Recommendations • Stakeholder input is critical for helping us understanding the transformative potential, feasibility, and impact of the measure recommendations we are considering. • We received invaluable input via survey responses from HAKR workgroup members on who to update, and how. Plan for gathering input 1. HAKR staff team will develop brief, plain-language written update on our workgroup purpose and progress. 2. HAKR staff team will give formal presentations to: • Early Learning Hub leaders: request that Hubs disseminate our written update throughout their Hubs (including governance committees and PACs) and to partners (including Head Start, Relief Nurseries, Parenting Education Hubs, home visiting programs, school districts, and Regional Achievement Collaboratives) • CCO Metrics Technical Advisory Group: request that CCO representatives disseminate our written update throughout their CCOs (including to Boards and CACs) 3. HAKR staff team will share written update with all parents/caregivers who participated in focus groups, and engage a small group of parents/caregivers in interviews to collect in-depth input on the proposals we are considering 4. HAKR staff team and workgroup members will disseminate written update to additional suggested stakeholders. We will create a tracking spreadsheet so all can see the groups we are reaching and support the dissemination effort. 5

Public Comment 6

“Near Ready” Metrics tha Metrics that t Ad Addr dress ess HAK HAKR R Wor orkg kgroup oup Priority Priority Ar Areas eas 7

Four “Near Ready” Metrics for Assessment Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Psychosocial Screening Using the Pediatric Symptom Checklist Tool • Maternal depression screening in child’s visits HAKR Conceptual Domain: Follow-Up to Address Risks Identified • Follow-up to developmental screening* + • Mental health utilization (Assessing Today) * Metric identified by Metrics & Scoring + Metric identified by Health Plan Quality Metrics 8

Mental Health Utilization - Developed by National Committee for Quality Assurance. - Based on claims data, for all ages. - Metric: Number and percentage of members receiving the mental health services during the measurement year (any service, inpatient, intensive outpatient or partial hospitalization, and outpatient or ED) - Modifications made by HAKR Staff Team to apply to children 0-6: - Narrow to age group to 0-5 (up to 6) - Identify specific services for children 0-5 (up to 6) aligned with OHA guidance on diagnostic criteria for children 0-5 - Considering two versions (this is part of the development work): - Version 1: Includes assessments & services - Version 2: Includes just services (goal) 9

Mental Health Utilization: Codes Examined for 0-6 Assessment Codes: • 96150-96154: Health and behavioral assessment (encounter to identify psychological, behavior, emotional, cognitive and social factors important to prevention, treatment, or management) • HOO31 : Mental health assessment, by non-physician. • H2000 : Child and adolescent needs survey (CANS) Services - Procedure Codes (CPT/HPCPS Procedure Codes) • 90832/90834/90837: Psychotherapy • 90846/90847: Family psychotherapy • 90791 : Psychiatric diagnostic evaluation • 90849 : Multiple-family group psychotherapy • 90882 : Environmental intervention for medical management purposes on a psychiatric patient’s behalf with agencies, employers or institutions. • HOO04 : Behavioral health counseling and therapy, per 15 minutes • H0038 : Self help/peer services, per 15 min • H2014 : Skills training and developmental, per 15 min • T1016 : Case management, per 15 min 10

Modified Mental Health Utilization Metric – Description: Percentage of children from 0-5 (up to age 6) who received mental health services – Data Source: Medicaid claims Equation: Child received behavioral health assessment or service = Children 0-5 who have been continuously enrolled for a year, allowing for one 45 day gap in enrollment 11

Data on the Current Level of Quality: Within Medicaid for CCOs Assessment & Assessment Service CCO Services ONLY Only CCO Range #1 8.1% 3.2% 5.7% Assessment & Service: 4.5-9.3% #2 6.2% 2.3% 4.9% #3 6.6% 4.5% 4.4% Services: 4.1%-8.0% #4 8.6% 3.1% 6.9% #5 4.8% 1.1% 4.3% #6 5.2% 2.1% 4.1% #7 4.5% 2.0% 3.3% Service Benchmark #8 7.0% 1.3% 6.3% 12-16% of children 0-6 have a #9 6.8% 3.4% 4.8% #10 8.3% 0.7% 8.0% mental health condition that #11 7.8% 1.7% 6.7% would benefit from mental #12 5.2% 1.4% 4.4% #13 7.2% 2.2% 6.4% health services #14 7.2% 2.6% 5.0% #15 5.4% 2.4% 4.4% #16 9.3% 3.1% 7.8% Statewide 6.0% 2.1% 4.9% 12

Data on the Current Level of Quality: Across Payers Data from All Payer All Claims Database (APAC) CY2017 period* Range Across Payers Assessment & Service: 1 – 5.9% Assessments Assessment Service PAYER & Services ONLY ONLY Services: 0.8 – 4.7% MEDICAID (members in CCOs)** 5.9% 2.1% 4.7% MEDICAID (open card) 4.8% 2.0% 3.6% Service Benchmark COMMERCIAL 1.1% 0.3% 0.9% 12-16% of children 0-6 have a PEBB 1.6% 0.4% 1.3% mental health condition that would benefit from mental OEBB 1.0% 0.2% 0.8% health services *APAC monthly enrollment data does not allow data by day or fraction of a month; therefore, continuous enrollment criteria used 11+ months in year **MMIS and APAC data systems have structural differences, meaning results will never match exactly. MMIS is the gold standard for CCO-level break-outs, whereas APAC is the only data source for comparing Medicaid to other payers in Oregon. 13

Work Needed to Develop a CCO-Level Metric Technical properties of the metric that need to be addressed: • Finalize specific codes to be included. • Obtain input and review by various CCOs and key stakeholders in the state. • Obtain input and guidance on inclusion of assessment services in the metric. • Clarify and address benchmark rates. Addressing feasibility of collecting the metric: • Given the metric is based on existing claims data, it is relatively feasible to collect. Degree to which the policies and payments are aligned with the metric: • Metric is aligned with the services outlined in OHA’s 0 -5 diagnostic crosswalk and outline of mental health services. • Opportunity to clarify policies and payments for these services within internal behavioral health services within primary care provider settings. 14

Relevant Information on the HAKR Measure Criteria • Evidence-Based and Relevant – Metric is aligned with assessment and services for which there is evidence of valid tools or effective treatments. • Outcome-Related – Specific services included in the metric have evidence of impact on a child’s social -emotional regulation, which is correlated with ability to learn and interact in a classroom setting. • Engages Health System – Engages the health system in the role of social-emotional health and importance of these services. • Engages Families – Potential to educate and inform families about the importance of early social-emotional health. • Family-Centered – A majority of the services are dyadic in natures, so they require partnership and engagement of the parent. • High Impact and Transformative – Many stakeholders, including early learning and K-12, have noted the importance of addressing mental health. • Promotes Cross-Sector Collaboration – To be successful would require primary care, internal behavioral health, specialty mental health, and building capacity within each sector. • Supports Equity – Disparities in availability of mental health services by region. – Disparities in utilization of services have been reported in the literature by race/ethnicity. 15

Mental Health Utilization PRE-Survey: Assessing Metric for Meeting HAKR Criteria The link below will take you to survey where you can indicate whether each of the criteria are met: https://www.surveymonkey.com/r/MHUtilization Discussion 16