Committee May 18, 2018 HEALTH POLICY & ANALYTICS Office of - - PowerPoint PPT Presentation

HEALTH POLICY & ANALYTICS Office of Health Analytics

Metrics & Scoring Committee

May 18, 2018

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Today’s Agenda

 Welcome

– Welcome Dr. Amit Shah! – Review and approve April minutes – HPQMC debrief – Updates (written and measure development) – CCO 2.0 standing update

 2019 measure set – prenatal care staff recommendation  Presentation on PCORI BHI study  Presentation on first Public Health Accountability Report  Discussion – 2019 measure set implications

Please note this meeting is being recorded. The recording will be made available on the Committee’s webpage: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-

Scoring-Committee.aspx

Review April Minutes

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Committee Appointments - Reminder

• In July 2018, two Committee members will ‘term out’, and five

additional members will need to reapply if they wish to continue from August 2018 on.

• All applications (including from current members who would need

to reapply) are due to metrics.questions@state.or.us by May 23rd.

• OHA is specifically looking for one member with oral health

expertise, and has an interest in members who can support the Committee in promoting health equity.

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Health Plan Quality Metrics Committee (1/2)

• Met May 10th

– Final review and approval of 2019 measure set, including identification

• f the following three ‘on deck’ measures (to be added to HPQMC list

in 2021)

• Current non-incentivized postpartum care measure will be replaced with ‘post-

partum follow-up and care coordination’

• Depression screening and follow-up for adolescents and adults will replace current

depression screening measure

• Optimal asthma control will replace asthma controller therapy on menu

– Discussed aligned measure set gaps to aid in prioritizing initial list of 20 developmental measures

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Health Plan Quality Metrics Committee (2/2)

• The following ‘developmental’ measures were prioritized:

– Developmental screening follow-up – Evidence obesity measure – Identification of suicide prevention measure – Kindergarten readiness – Children and youth with special health care needs survey (based on questions from FECC, PICS, and CAHPS) – Unexpected complications in term newborns – Food insecurity screening – Screening measure for Hep C and HIV (two measures, but potentially similar

• r parallel development process)
• Will meet again June 14th

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Measure Development Work

• Health aspects of kindergarten readiness measure

development

– Measure selection framework shared with ELC’s Measuring Success Committee, and aligns with framework being utilized for early learning system dashboard – Third meeting is May 25th. Discussion will include: adoption of measure selection criteria; application of conceptual framework; and review of potential measures for Phase 1 recommendations. – More substantive update (including framework) will be included in June M&S materials

• Evidence-based obesity measure

– Kick-off meeting scheduled for May 31st. – June M&S meeting will include check-in on scope, etc.

Standing CCO 2.0 Update

Stephanie Jarem, OHA

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HEALTH POLICY & ANALYTICS Office of Health Analytics

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Public testimony

2019 Prenatal / Postpartum Care Measure – OHA Staff Recommendation

Anna Stiefvater, RN, MPH - OHA Maternal and Child Health Sara Kleinschmit, MSc – OHA Office of Health Analytics

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Importance of Postpartum Care

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Fourth Trimester (3 months postpartum)

• Challenges

– Recovery from pregnancy, labor & delivery and newborn care – Return to tobacco use (and other substance use) – Fragmented care – Little formal or informal support

• Opportunities

– Reproductive life planning and contraception – Management of chronic health conditions – Linkages to ongoing care & services – Sensitive period of time with links to life course outcomes (maternal depression, breastfeeding)

State of Health Care Quality Report: HEDIS Measures of Care (United States)

POSTPARTUM VISIT BETWEEN 21 AND 56 DAYS AFTER DELIVERY Commercial Medicaid Medicare Year HMO PPO HMO HMO PPO 2016 74.1 65.9 63.7

• 2015

73.2 63.1 60.9 – – 2014 76.9 68.4 61.8 – – 2013 80.7 70.9 61.3 – – 2012 80.1 70.0 63.0 – – 2011 80.6 71.3 64.1 – – 2010 80.7 65.9 64.4 – –

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National Committee for Quality Assurance (NCQA) http://www.ncqa.org/report-cards/health-plans/state-of-health-care- quality/2017-table-of-contents/perinatal-care

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AMCHP Postpartum Think-Tank meeting, December 2014

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AMCHP Postpartum Think-Tank meeting, December 2014

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Key References

ACOG Optimizing Postpartum Care

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on- Obstetric-Practice/Optimizing-Postpartum-Care

Cornell, A., McCoy, C., Stampfel, C., Bonzon, E., & Verbiest, S. (2016). Creating New Strategies to Enhance Postpartum Health and Wellness. Maternal and Child Health Journal, 20(Suppl 1), 39–42.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290048/pdf/10995_2016_Article_2182.pdf

Resources on Strategies to Improve Postpartum Care Among Medicaid and CHIP Populations, Centers for Medicare & Medicaid Services (CMS)

https://www.medicaid.gov/medicaid/quality-of-care/downloads/strategies-to-improve-postpartum- care.pdf

CCO Performance, and Opportunity

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Statewide Performance – Preliminary 2017 Timeliness of prenatal care

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NOTE: 2011 and 2013 are not directly comparable to later years due to a change in methodology beginning in 2014 (inclusion of medical record data).

Statewide Performance – Preliminary 2017 Postpartum care rate

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NOTE: 2011 and 2013 are not directly comparable to later years due to a change in methodology beginning in 2014 (inclusion of medical record data).

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OHA staff recommendation

Bundle prenatal + postpartum care measure. To achieve measure, CCOs must meet benchmarks for both.

Rationale:

• Measures are part of a continuum of care, lending to joint accountability
• In 2021 HPQMC changing postpartum care measure to only include

women who make their appointment. Focus on supporting women in attending their visits now sets system up for success on this new measure.

• Aligns with efforts to reduce maternal mortality and morbidity and helps

address racial and ethnic disparities in this area (e.g., new Maternal Mortality and Morbidity Review Commission; inequities in postpartum outcomes for women of color).

• Work in postpartum arena supports CCOs in other areas, including

effective contraceptive use measure.

• Postpartum care essential to interconception health, setting state for

healthy subsequent pregnancy and birth.

• Should this be incentivized, OHA’s Transformation Center and Public Health

Division are poised to provide supports to CCOs to achieve the measure.

Discussion of OHA Proposal

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Caring aring for

• r th

the Wh Whole P

• le Person:

son:

A Patient-Centered Assessment of Integrated Care

Oregon CCO Metrics & Scoring Committee May 18, 2018

Bill J Wright, PhD Natalie Kenton, MS, MPH Acknowledgements This study was a partnership between CORE (The Center for Outcomes Research & Education at Providence St Joseph Health) and CHSE (The Center for Health Systems Effectiveness at OHSU). Support for the research was provided by PCORI (The Patient-Centered Outcomes Research Institute).

St Study udy Ob Object jectiv ives es

Measure the impact of integration, and the distinct elements of integration, on patient–centered outcomes. Measure the impact of integration, and the distinct elements of integration, on claims-based quality outcomes. Measure the impact of stigma on the integrated care

• utcomes that matter most to patients.

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Rethinking thinking In Integrat egration ion

OUR ORIGINAL RESEARCH PLAN FOCUSED ON STRUCTURAL INTEGRATION. We designed the study to look at structural and organizational changes of “integration.” OUR PATIENT ADVISORY TEAM ENCOURAGED US TO EXPAND OUR THINKING. The PAT told us that integration isn’t just a structural phenomenon to patients, it’s an experiential one. They were worried that stigma was a “first order” challenge for behavioral health integration, and that health systems weren't thinking much about this in their work. SO WE ADAPTED THE DESIGN: We changed our survey and interviews to include a third aim designed to explore the role of stigma in integration.

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How A Patient-Centered Lens Transformed Our Approach

Stu tudy dy Design esign

2 years of data from the clinics on their integration models. 2 years of survey responses from the patient panel. 2 years of in-depth interviews with patients & providers.

2 years of claims data from patients at study clinics.

WE FOLLOWED A RANDOM SAMPLE OF ABOUT 11,000 PATIENTS WHO WENT TO ONE OF OUR 12 PARTICIPATING CLINICS IN THE PORTLAND & BEND AREAS. WE ASSESSED OUTCOMES FOR PATIENTS AT EACH CLINIC; THEN TESTED WHETHER THE INTEGRATION ELEMENTS PRESENT IN THOSE CLINICS WERE ASSOCIATED WITH BETTER IMPROVEMENT IN OUTCOMES OVER TIME.

Patient-Reported Experience Outcomes (Chosen by the PAT)

Experience Measurement All Care Needs Met Got ALL needed care of any type (physical, mental health, substance use) Timely Access to Care Got appointments for all the above types of care as quickly as it was needed Hassle Free Care “Never” experienced hassle getting the needed care (vs sometimes/always) Provider Collaboration Reported “always” feeling like providers were talking to each other (vs never/sometimes)

We looked at whether people were more likely to have these kinds of positive experiences if they were in a clinic that was more integrated. We looked at integration in TOTAL and separately by DOMAIN.

Pa Patient ent-Ce Cent nter ered ed Ou Outcomes comes

POSITIVE INTEGRATED CARE EXPERIENCES: The PAT identified a set of things that would define having a positive integrated care experience. Higher scores mean success.

Systems ems Integration egration

Organizational Behavioral Health Integration

Domain (4-6 questions each) Measurement Integrated Care Staffing Employment of or partnership with behavioral health or substance use providers Integrated Care Training Training to work in a team-based care model Integrated Data Sharing Access to data across all domains of care Integrated Workflow/Collaboration Collaboration on treatment plans for patients with diverse care needs Integrated Financial Arrangements Provider shared risk for costs of patients or incentives for better care

OVERALL INTEGRATION SCORE: Each question was “scored” from 0 (not integrated at all) to 2 (fully integrated). The higher the score, the more integrated the clinic along that domain. We looked at the effect of OVERALL scores (0-50, with 50 being the most integrated possible clinic) and at individual DOMAIN scores to see if they were associated with better integrated care outcomes. Measured using a Clinic Audit Tool that asked clinic managers to identify where they were at on five distinct domains of integration. There were 25 questions split across five distinct domains:

Statis atistic tical al Meth ethods

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LOGISTIC REGRESSION: A statistical modeling method that lets us see how integration in clinics is associated with our outcomes while controlling for the influence of individual patient characteristics such as age, race, or payer type.

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OUTCOMES OVER TIME: Our models look at the interaction between integration and how outcomes change over time. So what we’re really testing is whether integrated clinics have better improvements in scores over time.

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WHAT ARE THE ODDS?: Our models tell us the odds ratio -- how the odds of having a good outcome change as a clinic’s integration score increases.

Odds Ratios below 1.0 tell us that the odds of a good

• utcome get worse as integration scores go up.

Odds Ratios above 1.0 tell us that the odds of a good

• utcome get better as integration scores go up.

ODDS RATIO

Res esults: lts: Integr egration ation & Pat & Patient ient Ou Outcomes comes

We looked at the effects of integration over time to see if clinics that were more integrated had better improvements in patient experience over time.

BOTTOM LINE: Clinic integration, at least during our study window, didn’t seem to directly impact patients’ self-reported outcome experiences. Results were similar for overall clinic integration & for each of our five integration domains. We did not find evidence that any of them impacted outcomes. Integration Over Time Effect OUTCOME Odds Ratio 95% C.I. p-value All care needs met 0.99 (0.97-1) 0.1358

Timely access to care 1.00 (0.98-1.02) 0.9082 No hassle to get care 0.99 (0.98-1.01) 0.3511 Provider communicate 1.00 (0.98-1.02) 0.9669

Odds Ratios are very close to 1.0, meaning overall integration scores weren’t really associated with better improvements in patient experiences over time. P-values over 0.05 indicate that the changes in odds of a positive outcome were not statistically significant. MODEL: OVERALL INTEGRATION SCORE.

Claims-Based Quality Outcomes (Analysis Completed by CHSE at OHSU)

Experience Measurement Avoidable ED Visits Number of ED visits with a primary diagnosis indicating potentially avoidable Follow-up After MH Hospitalization Discharges with visit to mental health practitioner w/in 7 days of discharge Medication Monitoring At least one therapeutic monitoring event during the measurement year HbA1C testing for those on antipsychotics Received a glucose screening within 12 months of latest dispense date LCL-C Testing for those on antipsychotics Received a lipid screening within 12 months of latest dispense date

Cla laims-Bas ased ed Qu Qual ality ty Ou Outcomes comes

APAC Derived Outcomes: OHSU’S Center for Health Systems Effectiveness (CHSE) derived a set of claims-based quality measures for all clinics in the study using APAC

• data. Key quality outcomes included:

We looked at whether patients at clinics with higher integration scores scored better on these metrics than patients at clinics with lower integration scores. We looked at integration in TOTAL and separately by DOMAIN.

Res esults: lts: Integr egration ation & Cl & Clai aims s Ou Outcomes comes

We looked at the effects of integration to see if clinics that were more integrated had better claims outcomes. This analysis was conducted by CHSE at OHSU.

BOTTOM LINE: Overall clinic integration didn’t have a strong impact on claims outcomes. However, results were better for some integration domains:

• Integrated care training helped reduce avoidable

ED visits.

• Integrated workflows helped improve medication

monitoring.

• Integrated financing helped improve post-MH

follow-up & medication monitoring. Integration Over Time Effect OUTCOME Effect Co-efficient p-value Avoidable ED visits 0.0001 0.593

Post-MH Hospital F/U 0.0045 0.705 Med Monitoring 0.0041 0.067 HbA1c/antispychotics 0.0032 0.110 LCL-C/antipsychotics 0.0003 0.878

These coefficients tell us how much quality scores increase for each point our 0-50 integration score goes up. These very small numbers mean the scores hardly go up at all as the integration score increases. P-values over 0.05 indicate that the effect

• f integration on claims outcomes were

not statistically significant, though they do get close in a few cases. MODEL: OVERALL INTEGRATION SCORE.

Res esults: lts: Stigma gma & Pat & Patient ient Ou Outcomes comes

We looked at the effects of past stigma experiences to see if patients who had avoided stigma experiences tended to have better patient experiences over time.

BOTTOM LINE: Stigma was strongly associated with a patient’s integrated care outcomes. Patients who had not experienced it had much better outcomes. Stigma was very common in our sample: 28% of patients reported having recently felt stigmatized by their primary care provider. This means nearly 1/3rd

• f patients belong to a group that is much less likely

to have positive integrated care experiences. Unadjusted Adjusted Models OUTCOME Stigma No Stigma Odds Ratio p-value All care needs met 38% 78% 4.66 <0.0001 Timely access to care 32% 60% 3.14 <0.0001 No hassle to get care 17% 60% 5.68 <0.0001 Provider communicate 20% 44% 2.92 <0.0001 Odds Ratios are well over 1.0, meaning patients who avoided stigma were much more likely to have positive integrated care outcomes. For example, patients without stigma had 4.66 times the odds of having all their care needs met than patients with stigma. P-values under 0.05 indicate that the changes in odds of a positive outcome were statistically significant. MODEL: STIGMA SCORE.

Res esults: lts: Integr egration ation & S & Sti tigma gma

We looked at the effects of integration on reported stigma experiences to see if behavioral health integration made it less likely for patients to report stigma experiences over time.

BOTTOM LINE: Most elements of integration didn’t really impact stigma, but integrated care training – which included specific trauma informed care and behavioral health training for providers – was associated with reduced patient stigma. Odds Ratios are close to 1.0, meaning integration didn’t really make stigma less common. However, there was one element of integration – integrated care training – that did reduce the likelihood of patients reporting stigma experiences. P-values are mostly non-significant. However, integrated care training has a under 0.05, indicating that it was associated with significantly reduced odds of patient stigma. Integration Over Time Effect OUTCOME Odds Ratio 95% C.I. p-value

Overall Integration 1.00 (0.98-1.02) 0.9271 Integrated Staffing 1.01 (0.96-1.06) 0.7441 Integrated Care Training 0.88 (0.81-0.95) 0.0008 Integrated Data 1.00 (0.95-1.05) 0.9402 Integrated Workflows 0.99 (0.92-1.06) 0.7248 Integrated Financing 1.05 (1-1.11) 0.0428

MODEL: OVERALL INTEGRATION SCORE.

“My doctor really hones in on the issue. She’s very – what’s the word? She shows

• compassion. She shows true care, [and] is

concerned with the issues I have. She’s very supportive.” “But they work as a team, and it’s really clear how and why they do work as a team. They do a really good job. They watch out for me in and out

• f the hospital – It’s a brand new thing.”

Systems ems Integration: egration: Pat Patient ent Inter ervie views ws

In talking to patients, we found that they weren’t that concerned with what system changes might be going on in their clinics. Their defining experiences took place through the lens of interactions with providers and staff at the clinics.

“Behavioral health consultant will do talks for our clinic about why it's important, and kind of refreshers for providers about how to best utilize

• her. And like what's appropriate and what's not.

She's always available.”

Systems ems Experi eriences: ences: Provider vider Inter ervi views ws

In talking to providers, we found that providers are generally hopeful about the potential benefits of BHI. BHI allows for more diverse staff and hands-on follow up, but incorporating integration into workflows is a learning curve.

“It absolutely helps with the workload. Just being able to go in to see a patient with chronic health issues [and address their concerns], it takes out 15 minutes so that I can spend time trying to go over their other concerns.”

“They're supposed to be there for you. I just felt

• judged. I felt like, because of how I told them about

my anxiety, needing help so desperately, and crying to them because I am not getting the help I needed, they thought I was crazy.”

Stig igma ma Experi eriences: ences: Pat Patient ient Inter ervi views ws

In talking to patients, we found that past stigma experiences were salient and formative, undermining many of the goals of systems-level BHI efforts. Patients were often reluctant to engage in the system because of past experiences, especially around chronic pain.

“Physical therapy is really expensive and I can't pay for it up

• front. I realize that physical therapy is a great thing, and it helps

many people, and it would probably help me. But it's not something I can afford in my life. Yet it's always the answer.”

“There’s variability around primary care providers’ ability to [show compassion] well. And I think because of fear, like not wanting your name on a prescription, sometimes PCPs probably don’t take an approach that would be perceived as

• compassionate. But I think they feel backed into a corner.

That’s hard.”

Stig igma ma Experi eriences: ences: Provider vider Inter ervi views ws

In talking to providers, we found that providers are caught between the systems and the

• patients. Specifically in terms of stigma, providers did not seem aware of their ability to

cause distress in patients. Providers often spoke about their behavior in terms of system constraints (limited appointment slots and prescription policies) making it difficult to be compassionate towards their patients.

Stigma

OUTCOMES THAT MATTER TO PATIENTS EXPERIENCES OF INTEGRATION

Integrated Staffing Integrated Training

STRUCTUAL INTEGRATION

Integrated Workflows Integrated Data Integrated Payment Better Access Timely Care Less Hassle Coordinated Experience

For Health Systems, Integration looks like structural & systems work:

For patients, integration is an experience, and their past experiences matter: How do we make the systems work translate into better experiences? The goal is to change patient experiences for the better:

Ret ethinking hinking Beh ehavioral

• ral Hea

ealt lth h Integr egration ation

SYSTEMS INT INTEGRATION IS IS THE MEANS, NOT THE EN END GO GOAL. Health systems often see integration as structural work: hiring new types of providers, training them, connecting data. For patients, integration is experiential, not structural. The structural stuff only matters if it impacts their experiences. SYSTEMS & PATIENTS MIG IGHT MEASURE WIN INS DIFF DIFFERENTLY. . There was at least some evidence that structural integration changed claims-based quality outcomes, but very little evidence it impacted patient experiences. Health systems are pretty good at moving the needle on traditional quality indicators, but these indicators may be disconnected from patient experiences.

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Ret ethinking hinking Beh ehavioral

• ral Hea

ealt lth h Integr egration ation

STIG TIGMA IS IS A A FIR FIRST-ORDER CH CHALLENGE FOR INT INTEGRATION.

Stigma experiences were strongly associated with patient experiences in a way that structural integration wasn’t. Patients want to be respected valued, and heard. They aren’t necessarily concerned about whether that happens in a more or less integrated setting. Patients who have felt stigmatized won’t engage in the system no matter how much you improve it.

OU OUR RESULTS CA CALL INT INTO QUESTION SO SOME FU FUNDAMENTAL ASS ASSUMPTIONS OF OF BHI BHI. .

Health systems have assumed integration is a slam-dunk win for themselves and for patients because it creates a “one stop” shop for getting your care needs met. For some patients, that “one stop” is the very place where they have historically felt the most stigmatized. Asking them to get MORE of their care there may seem like it is invalidating that history.

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Ret ethinking hinking Be Behavior

• ral

al Hea ealt lth h Integration egration

WE E MAY NEE EED TO BRI BRIDGE THE STIGMA GA GAP P FOR INT INTEGRATION TO WORK. Whether patients are “justified” in feeling stigmatized doesn’t matter – it still shapes how they engage. Integrated systems won’t be complete until we figure out how to engage patients who have not historically felt welcomed by them. THERE ARE RE THINGS TO BU BUIL ILD ON ON, BU BUT IT IT WIL ILL TAKE INT INTENTIONALITY. . There are things about integration that could help reduce stigma, but they will require intentionality. For instance, training of providers might need to move beyond the mechanics of integration to address stigma and patient experiences. SYSTEMS INT INTEGRATION MAY BE BE NECESSARY, BU BUT NOT SUF SUFFICI CIENT. The work of systems integration isn’t necessarily wasted effort –it may simply be the first & necessary step in a journey that must now grow to encompass efforts to address patient stigma around behavioral health.

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Time for a break.

Public Health Accountability Metrics Report

Jennifer Vines, MD, MPH Multnomah County Deputy Health Officer May 18, 2018

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Agenda for today

• Share findings from the Public Health Accountability

Metrics Baseline Report

• Discuss opportunities to build collaborations between the

health care and public health systems to achieve shared goals.

OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Public health accountability metrics

• ORS 431.115 requires the use of accountability metrics to

incentivize the effective and equitable provision of public health services.

• Public health accountability metrics will be used to track progress

toward population health goals through a modern public health system.

• PHAB is responsible for establishing public health accountability

metrics.

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Public Health Accountability Metrics Baseline Report

• Provides an in-depth look at how

Oregon’s public health system is doing today on key health issues.

• Annual reports will provide

information on where Oregon is making progress and where new approaches or additional resources are needed.

• In the future, local public health

authorities will receive incentive payments for achieving accountability metrics through the public health modernization funding formula.

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Framework for public health accountability metrics

Public health accountability metrics are comprised of two sets of measures:

1. Health outcome measures: Reflect population health priorities for the public health system. Require long-term focus and work across

• sectors. More than half of the health outcome measures align with

current CCO incentive measures. 2. Local public health process measures: Reflect the daily work of a local public health authority to make improvements in each health

• utcome measure.

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

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Public Health Accountability Metrics

Population health priority Health outcome measures Local public health process measures Communicable disease control Childhood immunization Percent of two-year olds who received recommended vaccines

• Percent of Vaccines for Children clinics that participate in the

Assessment, Feedback, Incentives and eXchange (AFIX) program Gonorrhea Gonorrhea incidence rate per 100,000 population

• Percent of gonorrhea cases that had at least one contact that

received treatment

• Percent of gonorrhea case reports with complete priority fields

Prevention and Health Promotion Tobacco use Percent of adults who smoke cigarettes

• Percent of population reached by tobacco-free county properties

policies

• Percent of population reached by tobacco retail licensure

policies Opioid overdose deaths Prescription opioid mortality rate per 100,000 population

• Percent of top opioid prescribers enrolled in the Prescription

Drug Monitoring Program (PDMP) Database Environmental Health Active transportation Percent of commuters who walk, bike or use public transportation to get to work

• Number of active transportation partner governing or leadership

boards with local public health authority representation Drinking water standards Percent of community water systems meeting health-based standards

• Percent of water systems surveys completed
• Percent of water quality alert responses
• Percent of priority non-compliers resolved

Access to Clinical Preventive Services Effective contraceptive use Percent of women at risk of unintended pregnancy who use effective methods of contraception

• Annual strategic plan that identifies gaps, barriers and
• pportunities for improving access to effective contraceptive use

Dental visits for children Percent of children age 0-5 with any dental visits

• This is a developmental measure. No process measure adopted.

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Key questions for Metrics and Scoring committee members

• What are opportunities to strengthen the relationships between

CCOs and public health?

• How can the Metrics and Scoring committee and PHAB support joint

efforts on areas with shared metrics?

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

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For more information

healthoregon.org/phab

OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Discussion – Implications for 2019 Measure Set

**the following slides are included as background, and will only be referenced in the meeting if needed

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Waiver Goals

Governor’s Direction for CCO 2.0 Waiver - Four Key Goals (p. 10) Increasing value-based payment Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health-related services, advances the use of value-based payments; Focus on social determinants of health and equity Increase the state’s focus on encouraging CCOs to address the social determinants of health and improve health equity across all low-income, vulnerable Oregonians to improve population health

• utcomes;

Maintaining a sustainable rate of growth Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health-related services, advances the use of value-based payments; Improving the behavioral health system Enhance Oregon’s Medicaid delivery system transformation with a stronger focus on integration of physical, behavioral, and oral health care through a performance- driven system aimed at improving health outcomes and continuing to bend the cost curve; Expand the coordinated care model by implementing innovative strategies for providing high-quality, cost-effective, person‐centered health care for Medicaid and Medicare dual- eligible members.

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Measure Selection Criteria (1/2)

Technical Measure Criterion

1. Evidence-based and scientifically acceptable 2. Has relevant benchmark 3. Not greatly influenced by patient case mix

Program-Specific Measure Criterion

• 4. Consistent with goals of program
• 5. Useable and relevant
• 6. Feasible to collect
• 7. Aligned with other measure sets
• 8. Promotes increased value
• 9. Present opportunity for QI
• 10. Transformative potential
• 11. Sufficient denominator size

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Measure Selection Criteria (2/2)

Measure Set Criteria

• 12. Representative of the array of services provided by the program
• 13. Representative of the diversity of patients served by the program
• 14. Not unreasonably burdensome to payers or providers

Health Measures Other Measures

Glide Path

Process Outcome 8 – 12 from the following:  Prevention  Childhood  Adulthood  Chronic Disease  Oral Health  Behavioral Health/A&D  Acute/Inpatient Care  Maternity Care 3-6 from the following:  Satisfaction/Patient Exp.  Social Determinants of Health  Health Equity/Race  Cost/Efficiency  Link to Public Health  Access

Metrics & Scoring Measure Set

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Wrap-Up Next Meeting: June 15, 2018

• Hear from OHA Public Health Division and QI

Director on health conditions needing improvement

• Revisit oral health measures
• Discuss behavioral health measures (CCO Oregon

presentation)