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

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP

August 27th, 2018

1

• 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

Agenda

2

3

Timeline and Work Plan

August

• Conclude review

and assessment

• f “near ready”

metrics

• Document

interest in “new” metrics

• Overview of all

“ready” and “near ready” metrics assessed

September

• Review

proposal(s) for potential measure recommendations with a phased approach

• Begin to discuss

components of glide path metrics

October

• Review draft

report with workgroup recommendations

• Discuss and

incorporate stakeholder input

• Build consensus
• n final

recommendations November

• Present final

recommendations to Metrics and Scoring Committee

Stakeholder Input About Our Work

4

5

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.

6

Public Comment

“Near Ready” Metrics tha Metrics that t Ad Addr dress ess HAK HAKR R Wor

• rkg

kgroup

• up

Priority Priority Ar Areas eas

7

8

Four “Near Ready” Metrics for Assessment

* Metric identified by Metrics & Scoring

+ Metric identified by Health Plan Quality Metrics

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)

• 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

• utpatient 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)

Mental Health Utilization

9

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

Mental Health Utilization: Codes Examined for 0-6

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:

=

Children 0-5 who have been continuously enrolled for a year, allowing for one 45 day gap in enrollment Child received behavioral health assessment or service

11

Data on the Current Level of Quality: Within Medicaid for CCOs

12

CCO Assessment & Services Assessment ONLY Service Only #1 8.1% 3.2% 5.7% #2 6.2% 2.3% 4.9% #3 6.6% 4.5% 4.4% #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% #8 7.0% 1.3% 6.3% #9 6.8% 3.4% 4.8% #10 8.3% 0.7% 8.0% #11 7.8% 1.7% 6.7% #12 5.2% 1.4% 4.4% #13 7.2% 2.2% 6.4% #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%

Service Benchmark 12-16% of children 0-6 have a mental health condition that would benefit from mental health services CCO Range Assessment & Service: 4.5-9.3% Services: 4.1%-8.0%

13

Data from All Payer All Claims Database (APAC) CY2017 period*

PAYER Assessments & Services Assessment ONLY Service ONLY MEDICAID (members in CCOs)** 5.9% 2.1% 4.7% MEDICAID (open card) 4.8% 2.0% 3.6% COMMERCIAL 1.1% 0.3% 0.9% PEBB 1.6% 0.4% 1.3% OEBB 1.0% 0.2% 0.8%

Range Across Payers Assessment & Service: 1 – 5.9% Services: 0.8 – 4.7%

*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.

Service Benchmark 12-16% of children 0-6 have a mental health condition that would benefit from mental health services

Data on the Current Level of Quality: Across Payers

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
• utline 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

15

• 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.

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

Mental Health Utilization POST-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

17

18

“New” Metric Concepts Concepts

18

“New” Metric Concepts to Review and Document HAKR Workgroup Input

❖ Social-emotional screening metric

• Based on claims data
• Would allow for various social-emotional screening tools (rather than specific to just one tool)

❖ Metrics proposed by HAKR workgroup members focused on high-quality preventive care for children ages 3-6

• 1. Bundle of metrics based on claims data related to preventive care for children 3-6
• Phase 1: Annual Well-Child visits, Preventive Dental Visit
• Phase 2: Annual Well-Child visits, Preventive Dental Visit, Social Emotional Screening
• Phase 3: Well-Child visits, Preventive Dental Visit, Social Emotional Screening, Behavioral

Health

• 2. Kindergarten readiness well-child visit, with oral health: based on claims & electronic health

record (EHR) data

• Phase 2: Annual Well-Child visits, Preventive Dental Visit (claims), PLUS EHR evidence of 3-5

quality elements in the visit

19

– Description: Percentage of children 3-6 who received a screening tool assessing social-emotional development – Data Source: Medicaid claims Equation:

=

Children ages 3-6 who have been continuously enrolled for 12 months, allowing for one 45 day gap in enrollment. Children with a claim of 96127 (brief emotional/behavioral assessment) in the last 12 months.

20

Social-Emotional Screening: Claims-Based Metric

Based on Measure Concept: High-Level Guestimate of Work Needed to Develop a CCO-Level Metric

Technical properties of the metric that need to be addressed:

• Clarify and confirm claim of 96127 recommended for the tools of focus.
• Clarify age parameters of the metric, anchored to the validity of the various tools across age groups.
• Engage stakeholders on the metric’s technical properties.

Addressing feasibility of collecting the metric:

• Clarify and understand payment and reimbursement practices for this claim across payers.
• It is unclear how many practice sites are currently screening, therefore CCOs will have to do practice-

level outreach and training on social-emotional screening. Degree to which the policies and payments are aligned with the metric:

• There is not a specific policy in Oregon around social emotional screening. Develop guidance on the

specific recommendations and which tools are aligned with the intent of the metric.

• There is not a specific policy providing clarification on billing for specific tools.
• Potential work with private payers on coverage given practices cannot differentially bill by insurance

type of their patients.

21

“New” Metric on Social-Emotional Screening: HAKR Workgroup Discussion

22

• What reflections do you have about the value of this new metric

being developed?

• On a scale of 0-10, how excited are you about this metric?
• What are your reflections about how this metric concept, if

developed, would align with the goals of our workgroup and the HAKR measure criteria?

• What barriers do you want us to understand and document in

describing this metric concept for future development?

• Received proposals from Helen Bellanca, Julie Harris, Suzanne McClintick,

and Dick Barsotti focused on metrics to operationalize high-quality preventive care

• Recognize concepts require longer term roll-out and growing impact.
• Given limited number of measurement slots, there is a potential value
• f a “bundle” metric of preventive care that would require cross-sector

collaboration

• Reviewed each metric and identified similarities in the concepts
• Presenting the shared and unique components to document HAKR

workgroup interest and support of the concepts for future development

“New” Metric Concepts Proposed by HAKR Workgroup Members Focused on High-Quality Preventive Care for Children 3-6

23

2020: 3-6yr Well-Child Visit (WV) Metric* 2021: Bundle measure: WV* + Preventive Dental Visit (DV)** 2022: Bundle measure: WV* + DV**+ Social-Emotional Screen (SE) – “New” metric to develop 2023: WV* + DV**+ SE + Behavioral Health: Preventive- and Treatment Focused - “New” metric to develop

* Based on the “Ready” Metrics Assessed ** Different age group for “ready metric”, but same specifications.

• 1. High-Quality Preventive Care Bundle Based on Claims Data

with Staggered Roll-Out

24

In addition to areas noted for the social-emotional screening metric:

Technical properties of the metric that need to be addressed:

• Clarify recommended care and specify claims for preventive behavioral health services.
• Engage stakeholders on these care processes and claims.

Addressing feasibility of collecting the metric:

• There is significant variation and lack of clarity on policies and payment of behavioral

services across payers, which impact the use of this claim. – Important to Note: Practices can’t differentially bill across payers. Degree to which the policies and payments are aligned with the metric:

• Develop guidance on preventive behavioral health services for children 0-5.
• Develop policy guidance on billing for specific tools.
• Work with private payers on coverage given practices cannot differentially bill by insurance

type of their patients.

25

Based on Measure Concept: High-Level Guestimate of Work Needed to Develop a CCO-Level Metric

• 1. High-Quality Preventive Care Bundle Based on Claims Data

with Staggered Roll Out: HAKR Workgroup Discussion

26

• What reflections do you have about the value of this preventive care

bundle?

• What reflections do you have about the value of the staggered roll out?
• On a scale of 0-10, how excited are you about this preventive care bundle

metric, based on claims data?

• What are your reflections about how this metric concept, if developed,

would align with the goals of our workgroup and the HAKR measure criteria?

• What barriers do you want us to understand and document in describing

this metric concept for future development?

• Proportion of children 3-6 who had a “kindergarten readiness” well-child visit in the measurement year.
• Phase 1: Bundle measure: WV* + Preventive Dental Visit (DV)** (each component required for credit)
• Phase 2: Bundle measure: WV* + Preventive Dental Visit (DV)** + EHR evidence of 3-5 quality

elements in the visit (each component required for credit)

1. One screen of a component of development (ASQ, ASQ-SE, MCHAT all count) 2. If evidence of concern on developmental screen, family and provider attest that follow-up has been done (could be EI, Help Me Grow, other community follow-up/assessment plan) 3. Family screened for behavioral health needs in caregivers or children 4. Family screened for social risk (housing, food, transportation, stress, need for parenting support) 5. Family counseled to spend at least 15 min a day reading/telling stories to children to promote early literacy 6. Nutrition/exercise counseling 7. Safety counseling (car seats, windows, choking, water safety) 8. Vision screening (added per HAKR workgroup discussions on vision screening)

• Phase 3: Early learning sector data on number of children whom they met with and offered education

and/or referrals for a similar set of items

* Based on the “Ready” Metric Assessed ** Age-Modification to “Ready” Metric Assessed

• 2. Kindergarten Readiness Well-Child Visit Bundle Based on

Claims & Electronic Health Record Data

27

In addition to areas noted for the social-emotional screening and behavioral health screening metrics: Technical properties of the metric that need to be addressed:

• Clarify numerator of metric; some children who did not come in for well-child visit may have received some EHR

quality components

• Develop detailed specifications for what would “count” and not count for each of the eight EHR components
• Develop detailed specifications of the follow-up components and what would count
• Develop EHR reporting specifications based on above
• Engage stakeholders on the various components

Addressing feasibility of collecting the metric:

• A number of these fields are not currently in searchable fields within the EHR.
• Practices would need to develop documentation and searchable fields aligned with the detailed specifications.

Degree to which the policies and payments are aligned with the metric:

• Develop policies for each component given all are not completely aligned with Bright Futures recommendations.
• Address variation in availability and capacity of services included in the follow-up metric.

28

Based on Measure Concept: High-Level Guestimate of Work Needed to Develop a CCO-Level Metric

• What reflections do you have about the value of this measure concept?
• On a scale of 0-10, how excited are you about this kindergarten readiness

bundle metric, based on claims data?

• What are your reflections about how this metric concept, if developed,

would align with the goals of our workgroup and the HAKR measure criteria?

• What barriers do you want us to understand and document in describing

this metric concept for future development?

29

• 2. Kindergarten Readiness Well-Child Visit Bundle: HAKR

Workgroup Discussion

30

Summary of Metrics Assessed & Next Steps

30

31

Options for Metric Proposals with Specific Metrics Assessed

32

Metrics Assessed by HAKR Criteria with Scores

Mental Health Assessment Scores Will be Entered During the Break

33

Health Plan Quality Metrics Committee Review of Proposed Metrics

#2-4 are on the HPQM measures menu. These metrics would need to be reviewed and endorsed by HPQM. #1 Needs to be endorsed by HPQM.

34

Current CCO Incentive Metrics, “Ready” Metrics, “Near Ready” Metrics

34

Mental Health Assessment Scores Will be Entered During the Break

1) A Only 2) A + B 3) A + B, Proposal for C 4) B + C 5) A, Proposal for C

Proposal Options:

35

Options for Proposals to Metrics and Scoring Committee in Fall 2018

HAKR Staff Team Development of Proposal(s) for Workgroup Review

36

• Develop proposal(s) for child-level metrics (A + C) with a phased approach.
• Assess each “set” by the HAKR composite measure criteria.

– Composite metric is parsimonious and limited in number of individual components. – Includes metrics which, in combination, measure the desired outcome by addressing the array of services that impact a child’s KR. – Includes metrics that utilize various data sources. – Includes measures with the most transformative potential to drive health system change and stimulate cross-sector collaboration.

• Consider proposals for “new” metrics and feasible options for incorporating into proposals.
• Consider options for recommendations to:

– Health Plan Quality Metrics – Metrics and Scoring (will need to be strategic, considering the below)

• Current and planned future metrics
• Overall need for limited set of metrics (currently 19 metrics)
• Metrics within HPQM measurement framework and by CCO service lines

37

• September meeting focused on reviewing proposal(s) for the

child-level metrics (A + C) with a phased approach.

• September and/or October Meeting: Review components of

the CCO-level glide path metrics (B)

• September Metrics & Scoring Committee meeting – provide

updates on potential HAKR proposal(s) – Get feedback and gut check on the proposal(s) being explored

HAKR Staff Team Development of Proposal(s) for Workgroup Review

Workgroup Reflections

38

THANK YOU!

Meeting Schedule September 11, 2018: 1 – 4 PM October 26, 2018: 12:30 – 3:30 PM

39