Committee June 15, 2018 HEALTH POLICY & ANALYTICS Office of - - PowerPoint PPT Presentation

HEALTH POLICY & ANALYTICS Office of Health Analytics

Metrics & Scoring Committee

June 15, 2018

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Today’s Agenda

 Welcome

– Review and approve May minutes – HPQMC debrief – Measure development updates (and guidance from Committee) – CCO 2.0 standing update

 Presentation on statewide areas for quality improvement  2019 measure set selection

– Review TAG and Committee homework – OHA staff recommendations and information for consideration – Begin selecting 2019 measure set! 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 May Minutes

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Committee Appointments

• Four Committee members termed out/chose not to reapply
• OHA is reviewing applications (including from those

reapplying)

• New Committee members will be invited to attend July

meeting (as non-voting members)

• New appointments begin in August

HPQMC Updates

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Measure set finalized for 2019. Available online and in packet:

https://www.oregon.gov/oha/HPA/ANALYTICS/Quality%20Metrics%20Committ ee%20Docs/2019-Aligned-Measures-Menu.pdf

• Measure Categories

– Menu: measures from which payers can choose – On Deck: measures that are not yet ready to be implemented, but have near-term potential – Developmental: measure concepts that address important areas of health/ outcomes but for which (generally) a specific measure has not been defined and/or not yet validated and/or tested

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Menu Set Highlights

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51 health care quality measures 6 domains of health care services (and 5 sub domains) Each measure has a measure steward Each measure is matched to at least one health care sector

Measure Categories: MENU, On Deck, Developmental

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Measure Categories: Menu, On Deck, DEVELOPMENTAL

Developmental: Measure concepts that address important areas of health/

• utcomes but for which a specific measure has not been defined and/or not yet

validated and/or tested  Twenty developmental measures with eight selected as highest priority.

– Evidence-based obesity measurement (in progress) – Health Aspects of Kindergarten Readiness (in progress) – Developmental screening in the first 36 months of life and follow-up – Suicide Risk Assessment – 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 or parallel development process)

June 14 meeting updates…

• The HPQMC meets the 2nd Thursday of each month. Meeting agendas,

minutes, materials, and recordings can be found on the committee website: http://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Quality-Metrics- Committee.aspx

Measure Development Work

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Obesity Metric Workgroup

• Met for the first time on May 31st

– Reviewed evidence on effective obesity interventions – Brainstormed potential components of an evidence- based obesity measure – Agreed that the measure developed:

• Move beyond just clinical interventions / components,

and is looking toward development of a multiple component, cross-sector measure

• Look at linkages with SDOH
• Is not duplicative of other metrics
• Feasibility is critical
• Next meet June 25th.

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Health Aspects of Kindergarten Readiness

• Fourth meeting was June 7th; meet again June 29th
• June 7th meeting was first time using conceptual

framework to assess measures that are already in existence

• Considering options for composite / phased measures

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CCO Incentive Measures: Health Aspects of Kindergarten Readiness

*Created by OPIP for HAKR Technical Work Group 5/25/18 meeting led by Children’s Institute and supported by OHA

Health Aspects of Kindergarten Readiness

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

OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Oregon’s health priorities:

Recommendations to the Metrics and Scoring Committee on areas of unmet need

Katrina Hedberg, MD, MPH Health Officer and State Epidemiologist Lisa Bui, MBA Quality Improvement Director June 22, 2018

Purpose for today’s discussion

• Provide update on progress toward meeting state health

improvement plan and other health priorities in Oregon.

• Highlight gaps in statewide performance and opportunities

for improvement through CCO metrics

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State Health Improvement Plan (SHIP) Priorities, 2015-2019

• Reduce tobacco use
• Slow the increase of obesity
• Reduce the harms associated with alcohol and substance

use

• Improve oral health
• Prevent deaths from suicide
• Improve immunization rates
• Protect the population from communicable disease
• Also, maternal and child health

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Currently in M&S Measurement Set

Prevent and reduce tobacco use

Decrease:

• Cigarette smoking

prevalence among youth

• Other tobacco product (non-

cigarette) use among youth

• Cigarette smoking

prevalence among adults

Prevent and reduce

• besity*

Decrease

• Obesity among 2- to 5-year-
• lds
• Obesity among youth
• Obesity among adults
• Diabetes among adults

*glide path workgroup started for a evidence based metric

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Currently in M&S Measurement Set

Improve Immunization rates

Increase:

• Rate of 2-year-olds who are

fully vaccinated

• HPV vaccination series rate

among 13- to 17-year-olds

• Seasonal flu vaccination

rates in people ≥6 months of age Existing CCO measures for improving maternal and child health

• Effective contraceptive use

among women at risk of unintended pregnancy

• Timeliness of prenatal care;

consider adding postpartum measure component

• Developmental screening in

the first 36 months of life

(Enter) DEPARTMENT (ALL CAPS) (Enter) Division or Office (Mixed Case)

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Maternal and Child Health

Improve oral health

Priority targets Decrease

• Third graders with cavities in their permanent teeth
• Adolescents who have ever had a cavity
• Prevalence of older adults who have lost all their natural teeth

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Key strategies for improving oral health

Population interventions 1. Increase the number of fluoridated public water districts Health system interventions 1. Adopt incentives for improving oral health

1. CCO incentive metric: Dental sealants on permanent molars for children

2. Increase early preventive care for children 3. Include oral health in chronic disease prevention and management

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Children with dental visit in the past year, by age group

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80% 54% 93% 93% 90%

0% 20% 40% 60% 80% 100% Total 0–5 6–9 10–13 14–17 Percent of children Age group in years

2016 National Survey of Children's Health Source:

Total

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Prevent deaths from suicide

Priority targets Decrease

• Rate of suicide
• Suicide attempts among 8th graders
• Emergency department visits for suicide attempts

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Key strategies for suicide prevention

Population interventions 1. Promote use of the National Suicide Prevention Lifeline 2. Ensure communities implement services and programs to promote safe and nurturing environments Health system interventions 1. Adopt incentive measures for suicide prevention

a) CCO incentive measure: Depression screening and follow up plan b) State performance measure: Follow-up after hospitalization for mental illness

2. Establish universal screening for individuals at risk of suicide

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Suicide deaths by year, Oregon and US

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14.1 Oregon 17.8 10.4 U.S 13.3

4 8 12 16 20 Rate per 100,000 residents (age-adjusted)

CDC's WISQARS Source:

Suicide deaths by age and sex, Oregon

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4.3 5.6 8.8 13.9 7.8 7.3 28.5 32.9 38.8 42.7

5 10 15 20 25 30 35 40 45 10 to 17 18 to 24 25 to 44 45 to 64 65+ Rate per 100,000 residents Age in years

CDC's WISQARS Source:

Female Male

Protect the population from communicable diseases

Priority targets Decrease:

• Gonorrhea in women aged 15 – 44 years
• HIV infections in Oregon residents
• Hospital-onset Clostridium difficile infections
• Infections caused by the Shiga toxin-producing Escherichia coli

infections in children under 10 years

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Key strategies for communicable disease control

Population interventions 1. Reduce non-judicious antibiotic prescriptions Health system interventions 1. Adopt incentives for communicable disease control

a) State performance measure: Percent of two year-olds who received recommended vaccines b) HPQMC developmental measure areas for HIV and hepatitis C screening

• 2. Promote use of expedited partner therapy by health care providers

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HIV diagnoses and deaths, Oregon

Racial disparities in HCV outcomes, Oregon, 2009-2013

127.7 124.4 57.5

50 100 150

4.1 5.1 3.1

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17.4 16.1 8.9

20 AI/AN Black White

Liver Cancer Deaths Chronic HCV

Reduce harms associated with alcohol and substance abuse

Priority targets Decrease

• Prescription opioid mortality
• Alcohol-related motor vehicle deaths

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Key strategies for reducing harms from alcohol and substance use disorders

Population interventions 1. Increase the price of alcohol Health system interventions 1. Incentives for alcohol and substance use screening, treatment and prevention

a) State performance measure: screening and referral to treatment for alcohol or other substance use disorders (SBIRT)

2. Reduce high risk opioid prescribing

a) Statewide PIP

3. Ensure access to evidence-based pain management 4. Ensure access to alcohol and substance use disorder treatment

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Opioid overdose mortality by year, Oregon

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2.1 6.5

1 2 3 4 5 6 7 8 9 10 Rate per 100,000 residents

Oregon Death Certificate Data Source:

Alcohol-related deaths by year, Oregon

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30 39

10 20 30 40 50 60 Rate per 100,000 (age-adjusted)

Oregon Death Certificate Data Source:

Alcohol-related deaths by age and sex; Oregon, 2016

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9 15 45 69 24 37 107 131

30 60 90 120 150 15–24 25–44 45–64 65+ Rate per 100,000 residents Age group in years

Oregon Death Certificate Data Source:

Female Male

Adult binge drinking by sex and year

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22.7% Males 23.1% 7.6% Females 13.3%

0% 5% 10% 15% 20% 25% Percent of adults (age-adjusted)

Oregon Behavioral Risk Factor Surveillance System (BRFSS) Source: Starting in 2010, estimates are not comparable to earlier years.

Recommended Area of Focus

State Health Improvement Plan (SHIP) Priorities, 2015-2019

• Reduce tobacco use
• Slow the increase of obesity
• Reduce the harms associated with alcohol and substance use
• Improve oral health
• Prevent deaths from suicide
• Improve immunization rates
• Protect the population from communicable disease
• Also, maternal and child health

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Alignment to Quality

• Community Health Improvement Plans

– Areas of Focus: Clinical, Public Health, Social, Equity

• Transformation and Quality Strategy (TQS)

– Key Components: Integration, Value Base Payment models, Oral Health, Utilization, Complaints and Grievance

• Performance Improvement Projects

– Statewide PIP

• 2016-2019: Chronic Opioid use reduction strategies
• 2019-2021: Appropriate Acute Prescribing of Opioids

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Next Steps

• M&S can add the post partum element to the existing

timeliness to prenatal care and/or just add post partum care separately

• M&S can explore alcohol and substance abuse potential

measures and advocate to HPQMC for inclusion into 2020 menu

• M&S can adopt oral health metrics for adults from HPQMC

measure set Potential:

• Katrina and Lisa to present at HPQMC

Questions: OHA.Qualityquestions@state.or.us

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Review TAG and Committee Homework (see handout)

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2019 measure set: OHA staff recommendations and information for consideration

• DHS custody measure
• Smoking cessation
• Weight assessment & counseling
• Oral health measures
• PCPCH measure

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Assessments for Children and Youth in DHS Custody

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Statewide Performance – Preliminary 2017 DHS Custody

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Current Metric Does Not Align with DHS CW Policy and AAP Recommendations

Component OHA CCO specs DHS OAR 413-015-0465 age timeline age timeline Physical health assessment 0-17 60 days 0-17 30 days Dental health assessment 1-17 60 days 1-17 30 days Mental health assessment 4-17 60 days 3 - 17 60 days Additional requirements not in current measure: Intake nursing assessment by a DHS contracted nurse, shortly after entering care 0-17 shortly after entering care Child and Adolescent Needs and Strengths (CANS) screening 0-17 60 days Early Intervention Screening 0-2 60 days

• American Academy of Pediatrics - see page 22: https://www.aap.org/en-us/advocacy-and-policy/aap-

health-initiatives/healthy-foster-care-america/Documents/Ch2_PP_Primary.pdf#Page=12

• Child Welfare Policy: OAR 413-015-0465
• Also note House Bill 3372 of 2017 requires CCOs to perform initial health assessments in accordance

with the metric established by the Metrics and Scoring Committee.

Opportunity

• In current state, many potential instances of duplicative

work.

• Since January 2018, DHS offices have been tracking and

reporting on DHS policy in relation to these assessments.

• This creates an opportunity for alignment between what the

DHS offices are tracking per their policies, and what is being tracked at the CCO level for the incentive metric.

• Current work and enthusiasm in this area from both OHA

and DHS Child Welfare creates an opportunity to better align and coordinate across sectors to better meet the needs of these children and youth.

Joint DHS Child Welfare / OHA Staff Recommendation

• Update the specifications to align with Child Welfare policy / AAP

recommendations.

• To allow time for OHA and DHS to work with CCOs to get more timely

reporting processes in place to meet the revised specification, and to build the infrastructure to support better coordination among CCOs and Child Welfare (both central office and local branches), do not include a target for this measure in 2019.

• Use 2019 to build this infrastructure and establish a baseline for 2020

improvement targets.

• Per HPQMC precedent, formally note in the 2019 measure set that the

revised version of this measure will be included in the 2020 incentive measure pool.

Discussion of joint DHS Child Welfare / OHA Proposal

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Smoking prevalence measure

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Smoking Prevalence Measure

Goals for today:

• Discuss concerns about current version of smoking prevalence

measure

• Get direction from Committee about potential shift to NQF-endorsed

measure

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Smoking Prevalence Measure Components

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Background

• State-specific measure was developed to measure

prevalence rather than process

• NQF-endorsed measure spec changes for 2018

– Tobacco use screening and cessation intervention (NQF0028/ CMS138) specs changed for 2018 to break out three rates – Break-out would allow calculation of tobacco prevalence from the NQF-endorsed measure

• In state-specific measure, we now have reached glide path

goal on cessation benefit component (must meet prevalence target to achieve measure beginning in 2018)

• In previous discussion, Metrics and Scoring Committee

chose to retain the state-specific measure

Data Validity Concerns

• Variation in denominator calculation methods

– “Unique patients age 13 or older seen by the eligible professional during the EHR reporting period” (with custom query to limit to Medicaid only) – “All patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement period” (with custom query to broaden to 13 or older and to limit to Medicaid only)

• Distinguishing cigarette smokers (smoking prevalence rate) from

cigar or pipe smoking (included with snuff and chew in broader tobacco use rate)

• Potential data to be skewed by pediatric population
• Discussed with Metrics TAG in May and heard feedback in favor of

switching to NQF-endorsed tobacco measure

Staff Recommendation

• Drop the cessation benefit component, as CCOs have achieved this

goal

• Continue to benchmark prevalence, but shift from state-specific

measure to NQF-endorsed tobacco screening and cessation intervention measure included on the HPQMC measure set

– Would address data validity concerns and lead to more consistent reporting across CCOs – Overtly shifts measure from cigarette smoking to tobacco use – Focuses on adult population only, so less concern regarding data being skewed by pediatric population

• Population threshold would ‘start over’ at 25%
• Intention: Continue focus on prevalence outcome, and calculate it in

a more standard way

Smoking Prevalence Measure – EHR- based prevalence data

Tobacco Use: Screening and Cessation Intervention (2018)

2018 Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents –NQF 0024

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Here We Will--

• Check in on the BMI assessment and counseling for

nutrition/physical activity for children and adolescents measure to evaluate for 2019

• What is the evidence with BMI and weight?
• How does the measure connect to future if at all?
• Is it something that will continue to work or not?

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Review of the Metric--

• Three parts:
• BMI
• Counseling for Nutrition
• Counseling for Physical Activity
• Metric calculation is based on an average of all three
• Was selected for 2018 as a glide path for future

evidence-based measure that focuses on obesity

• Work group to develop the evidence-based measure

convened in late May to develop a new measure

• Robert Wood Johnson reports 17 states use this

measure as a preventive health measure (a)

• Emphasis is on weight assessment and HEALTH

MAINTENANCE through diet and nutrition

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Known Evidence--

• BMI is sensitive to racial group differences due to its

reliance on height. To get around this issue, obesity is

• ften set at 95th or 99th percentile for the population (b)
• BMI standard scores for specific ages and sex that

look at number of standard deviations from the average for a population (called BMI zscore) (c)

• BMI is not a reliable predictor of obesity in children

under 9 years old—using a validity test with BMIz score and an absorptiometry test of fat %. BMIz score is a strong predictor for 9-18(d)

• This metric doesn’t emphasize obesity but is meant as

an ASSESSMENT of whether counseling happened

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Benefits--

• Checks in on the weight assessment and counseling

for nutrition/physical activity for children and adolescents measure so it gets prioritized during visit

• This is a health maintenance issue for all children and

adolescents

• Clinicians are likely experienced in this counseling

and communication

• Sometimes a child will hear things better from their

doctor visit rather than a parent

• The measure prepares for the evidence-based

measure to come in two years

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Concerns--

• Potential stigmatizing of children and adolescents?
• There is some evidence that there are different BMI

cut offs for minority children due to BMI reliance on height and currently no emphasis on overweight and

• bese in the metric
• Currently unsure of the future, new measure’s content
• r focus as it is being developed by subject matter

experts

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Options--

• Keep for 2019 because benefits outweigh concerns-

stay with current measure

• Drop for 2019 - wait for the new evidence-based
• besity measure
• Some other action

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References

a) Robert Wood Johnson 2018 Most Frequently Used State Program Measures, by Domain, http://www.buyingvalue.org/resources/toolkit/. b) Nightingale, CM, et al. Patters of body size and adiposity among UK children of South Asian, black African-Caribean and white European

• rigins: Child Heart and health Study in England (CHASE Study),

International Journal of Epidemiology 2011, 40, 33-44. (c) Hoelscher, D.M., Kirk, S., et al. Position of the Academy of Nutrition and Dietetics: Interventions for the Prevention and Treatemnt of Pediatrics Overweight and Obesity, Journal of the Academy of Nutrition and Dietetics, 2013, 1375-1394. (d) Vanderwall et al. BMI is a poor predictor of dadiposity in young

• verweight and obese children, BMC Pediatrics 2017.

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Oral Health Measures

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Dental Sealants on Permanent Molars for Children

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Statewide Performance – Preliminary 2017 Dental Sealants

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Comparison of Oregon specifications versus DQA specifications (sealants)

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Current CCO specifications DQA specifications Which teeth counted in numerator? Count all permanent molars Sealant must be on first molar (6- 9); second molar (10-14) Who is included in denominator? All children on Medicaid ages 6-14 meeting continuous enrollment criteria Only children at elevated caries risk are included, as identified by:

• Visit D0602 (moderate caries

risk) or D0603 (high caries risk) during measurement year

• Service code from a list of CDT

codes indicating restorative service in either the measurement year or in the 3 years prior to the measurement year

Dental Sealant Measure History (1/2)

• Was previous concern that risk codes were not being used extensively,

which led to the decision to include all children in denominator:

– Nov 2016 presented initial information on testing the dental sealant measure with denominator criteria for children at elevated risk. – Found use of risk coding increased from 2014 – 2015, but still rare. – Most children at ‘elevated risk’ were due to use of a restorative service, not the use of a risk code. – Determined that, using 2015 data applying elevated risk criteria (risk coding + restorative service) decreased the denominator by 66% (87K children in CY 2015) raised measure performance 11%.

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Dental Sealant Measure History (2/2)

• The following slides show that while the use of any risk codes generally

remains low across most CCOs, it has increased from 2015 to 2017.

• In addition, the impact on the denominator has shifted:

– Applying the elevated risk criteria from the DQA specs (risk code + restorative service) decreases the denominator by 43% (54,781 children in CY 2017) and raises statewide performance by 5.3 percentage points. – As in 2017, when using risk claims (risk code + restorative services), a significant number of children are added to the denominator due to restorative services.

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Comparison of Current OHA vs DQA Specs, 2017 (preliminary, unvalidated data)

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Den. Num. Rate Den. Num. Rate ADVANCED HEALTH 2,327 644 27.7% 1,281 445 34.7%

• 45%

7.1% ALLCARE 6,635 1,582 23.8% 3,722 1,073 28.8%

• 44%

5.0% CASCADE HEALTH ALLIANCE- 2,244 492 21.9% 1,311 336 25.6%

• 42%

3.7% COLUMBIA PACIFIC CCO 3,225 759 23.5% 1,586 447 28.2%

• 51%

4.6% EASTERN OREGON CCO 7,866 1,930 24.5% 5,203 1,590 30.6%

• 34%

6.0% FAMILYCARE 15,509 3,591 23.2% 8,688 2,433 28.0%

• 44%

4.8% HEALTH SHARE OF OREGON 31,094 7,942 25.5% 18,718 5,607 30.0%

• 40%

4.4% INTERCOMMUNITY HEALTH NETWORK 7,513 1,782 23.7% 4,039 1,223 30.3%

• 46%

6.6% JACKSON CARE CONNECT 4,550 1,183 26.0% 2,790 824 29.5%

• 39%

3.5% PACIFICSOURCE GORGE 2,112 565 26.8% 1,156 376 32.5%

• 45%

5.8% PACIFICSOURCE CENTRAL 7,238 1,708 23.6% 3,972 1,265 31.8%

• 45%

8.3% PRIMARYHEALTH JOSEPHINE CO 1,051 235 22.4% 574 152 26.5%

• 45%

4.1% TRILLIUM COMMUNITY HEALTH PLAN 11,698 2,701 23.1% 6,164 1,811 29.4%

• 47%

6.3% UMPQUA HEALTH ALLIANCE 3,486 781 22.4% 2,016 558 27.7%

• 42%

5.3% WILLAMETTE VALLEY COMM. HEALTH 17,874 3,941 22.0% 9,982 2,702 27.1%

• 44%

5.0% YAMHILL COMMUNITY CARE 3,820 879 23.0% 2,259 656 29.0%

• 41%

6.0% STATEWIDE RATE 128,242 30,715 24.0% 73,461 21,498 29.3%

• 43%

5.3% DQA specs (elevated risk criteria) Current OHA CCO specs (no risk algorithm)

• Den. -

% change Rate - % Pt. Change CCO

OHA Staff Recommendation

• Continue current measure in 2019, with current specifications

(including all children, regardless of risk coding/claims).

• However, formally note that the DQA specifications will be followed

by OHA beginning in 2020 (formally on ‘on deck’ Metrics & Scoring list).

• This allows time for increased use of risk coding and education

throughout 2019.

• OHA can include this information in education and training offered

to providers throughout 2019, in anticipation of this change in 2020.

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Dental Care for Adults with Diabetes

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OHA Staff Recommendation

• Oral healthcare is an integral component of overall health.
• Oregon is one of few states to cover oral healthcare for adults, and

it is important that it be of a high quality.

• Moreover, integration of oral, physical, and mental health services

is a cornerstone of transformation efforts in our state.

• Therefore, OHA staff recommend that the Metrics & Scoring

Committee include a measure of oral healthcare for adults in the 2019 measure set, specifically the DQA ‘Adults with Diabetes – Oral Evaluation’ measure.

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Comparison of Oregon specifications versus DQA specifications (diabetes)

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Current CCO specifications DQA specifications Numerator credit? Receive at last one comprehensive, periodic, or periodontal oral evaluation (CDT codes D0120, D0150, or D0180) Same Who is included in denominator?

• Based on HEDIS comprehensive diabetes care

measure

• Ages 18-75 with diabetes

*2 outpatient, observation, or ED visits on different dates of service with a diagnosis of diabetes OR *>=1 acute inpatient encounter with diabetes diagnosis OR *Dispensed insulin or hypoglycemic /antihyperglycemics on an ambulatory basis *Only patients with Type 1 or 2 (exclude those with diagnosis of secondary diabetes due to another condition)

• Also use HEDIS comprehensive

diabetes measure to identify diabetic status

• *Potentially excludes patients

with gestational diabetes *Awaiting clarification from ADA

Discussion staff adult oral health measure recommendation

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PCPCH Measure

• In 2017 the formula for calculating the weighted score used to assess

performance on this measure was adjusted to account for the inclusion

• f additional tiers in the PCPCH designations.
• While preliminary data from 2017 show all CCOs performing above the

2017 threshold (weighted score of 60.0%), there is variation among the CCOs with regard to PCPCH tier.

• This weighted score has not been adjusted since the measure was first

included in the program.

• OHA staff recommendation: To incentivize contracting with clinics
• f higher tiers, continue the measure in 2019, but increase

threshold.

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Tier 1 Tier 2 Tier 3 Tier 4 5 STAR TOTAL Statewide total members 495 7,313 203,396 466,731 88,511 766,446 Statewide percentage 0% 1% 27% 61% 12% 100% Range across CCOs

• 0-2%

0% - 66% 17% - 85% 0%- 56%

• Members assigned to recognized PCPCH practices -

preliminary 2017 data

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Time for a break.

Select 2019 Measure Set!

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

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2018 Incentive Measures

• 1. Access to care (CAHPS survey)
• 10. Dental sealants for kids

2.Adolescent well-care visits

• 11. Depression screening and f/u plan
• 3. Emergency department utilization
• 12. Developmental screenings****
• 4. Assessments for kids in DHS

custody****

• 13. Diabetes HbA1c poor control
• 5. Childhood immunization status****
• 14. Disparity measure: ED utilization for

members with mental illness

• 6. Cigarette smoking prevalence
• 15. Effective contraceptive use
• 7. Colorectal cancer screening
• 16. PCPCH enrollment
• 8. Controlling high blood pressure
• 17. Weight assessment and counseling

for kids and adolescents

• 9. Timely prenatal care****

****=challenge pool, (challenge pool focuses on early childhood health; Committee ultimately wants a measure of kindergarten readiness)

CCO Incentive Measures since 2013

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CCO Incentive Measures 2013 2014 2015 2016 2017 2018 Adolescent well-care visits x x x x x x Alcohol or other substance misuse screening (SBIRT) x x x x Ambulatory care: Emergency department (ED) visits x x x x x x CAHPS composite: Access to care x x x x x x CAHPS composite: Satisfaction with care x x x x x Childhood immunization status x x x Cigarette smoking prevalence x x x Colorectal cancer screening x x x x x x Controlling high blood pressure x x x x x x Dental sealants x x x x Depression screening and follow-up plan x x x x x x Developmental screening (0-36 months) x x x x x x Disparity measure: ED visits among members with mental illness x Early elective delivery x x Diabetes: HbA1c poor control x x x x x x Effective contraceptive use x x x x Electronic health record adoption x x x Follow-up after hospitalization for mental illness x x x x x Follow-up for children prescribed ADHD medication x x Health assessments within 60 days for children in DHS custody x x x x x x Patient centered primary care home enrollment x x x x x x Timeliness of prenatal care x x x x x x Weight assessment and counseling for children and adolescents x

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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: July 20, 2018

• Review 2017 incentive measure report
• Check-in with Health Aspects of Kindergarten Readiness

Measurement group and CCO 2.0 update

• Update on SBIRT measure and finalize 2019 measure set
• Begin selecting 2019 benchmarks