Committee February 16, 2018 HEALTH POLICY & ANALYTICS Office - - PowerPoint PPT Presentation

HEALTH POLICY & ANALYTICS Office of Health Analytics

Metrics & Scoring Committee

February 16, 2018

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Today’s Agenda

 Welcome

– Review and approve January minutes – Select vice-chair

 HPQMC debrief  CCO midyear report  Context – Medicaid waiver  Program structure

– HPQMC – Discussion 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

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Measure Development Work

• Health aspects of kindergarten readiness measure

development

– Final roster is here: http://www.oregon.gov/oha/HPA/ANALYTICS/Kindergarten%20Readiness% 20Meeting%20Docs/Roster.pdf – First meeting is March 9th.

• Evidence-based obesity measure

– Project plan complete, to be shared with Committee – Kick off meeting tentatively scheduled to occur in April

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Vice-Chair elections

HEALTH POLICY & ANALYTICS Office of Health Analytics

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Public testimony

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Health Plan Quality Metrics Committee (1/2)

• Met February 8th and:

– Heard recommendations for State Health Improvement Plan metrics

• Adolescent vaccinations, including HPV series [change from combo 1 to combo 2]
• HIV screening

– Heard Behavioral Health Collaborative metrics proposal

• FU after ED visit for MH or Alcohol or Other Drug use (AOD)
• Suicide Risk Assessment for Individuals Aged 6+ Diagnosed with Major Depressive

Disorder

• Cardiovascular Screening for People with Cardiovascular Disease and

Schizophrenia

• Diabetes Screening for People with Diabetes and Schizophrenia
• Depression Response at 6 and 12 Months –Progress Towards Remission

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Health Plan Quality Metrics Committee (2/2)

– Continued discussion of following domains:

• Patient Experience
• Provider Satisfaction/Experience
• Cost/Efficiency
• Access
• Next meet March 8, 1-4pm
• Meeting information and materials are available online at:

http://www.oregon.gov/oha/hpa/analytics/Pages/Quality-Metrics- Committee.aspx

OFFICE OF HEALTH ANALYICS Health Policy and Analytics

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OFFICE OF HEALTH ANALYICS Health Policy and Analytics

What’s a deep dive?

• Abbreviated “dot chart” portion of the mid-year report in order to

make room for “deep dives” on metrics: Adolescent well care, effective contraceptive use, and ED utilization.

• Explore the demographics behind the performance
• Slicing the data in various ways.
• In the case of ECU and AWC, explored relationships between the

metrics.

• Not intended to uncover specific answers; rather, goal = to spark

further conversation and encourage CCOs to dig more deeply into their own data and reveal potential areas for further analysis.

OFFICE OF HEALTH ANALYICS Health Policy and Analytics

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OFFICE OF HEALTH ANALYICS Health Policy and Analytics

When comparing the top 20 diagnoses among members with SPMI by CCO, there is little overall variation. However, many CCOs have diagnoses in their top 20 that differ from the statewide top 20, including: Suicide and intentional self-injury

• Statewide among members with SPMI this diagnosis ranks #22.

However, in some CCOs the diagnosis ranks a high as #13, making up 2.6 percent of all ED visits.

• Statewide among members without SPMI, suicide and intentional self-

injury ranks just #175 among all diagnoses and makes up 0.1 percent

• f ED visits.

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HEALTH POLICY & ANALYTICS Office of Health Analytics

Demonstration Waiver 1115 Program Evaluation

February 16, 2018 Summary by Valerie T Stewart, Ph.D. Metrics and Evaluation Manager

Purpose--

• Organizationally where does Evaluation sit in relation

to Quality Metrics?

• Define Medicaid Demonstration Waiver 1115
• Why Evaluate the Demonstration?
• Underlying example questions in an evaluation
• Major findings from 2012-17 Evaluation just completed
• Current waiver evaluation- theoretical foundation—

evaluation plan is still in review and so tentative

• Relationship of CCOs to Evaluation Plan
• Relationship of Incentive Metrics to Evaluation Plan

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Agency Overview

Evaluation

SIM Waiver

Research & Data Data Integration

Coverage & Access

OHIS Uninsurance estimates ACS/NHIS

Finance & Cost

SHEW Medicaid Expansion estimates

Workforce

Licensing data Physician Workforce

Transparency & Reporting

Data Hub? Consumer Price Info (SB 900)?

APAC

DCBS Cycle III APAC TAG Data Collection Reporting

Data Gov, Privacy & Security

ISPO/DOJ Liaison

Hospitals & Facilities

Inpatient Outpatient Databank Community Benefit Audited Financial Capital Projects ASC (APAC dataset) Price Transparency

Data Strategy & Integration

Cross‐ agency: ASU, ICS, EDIE, Provider Directory, Public Health

Data Systems & Infrastructure

Data Warehousing HAL Server Data Quality Data Documentation Sharepoint, BI OIS Liaison

CCO Metrics

CORE Dashboard Metrics Committee Metrics TAG

Metrics

Hospital Metrics (HTPP)

Hospital Committee Hospital TAG

Health Plan Quality Metrics (SB 440) OHP/Medicaid Support

Reports and dashboards Analyses

Program Analysis & Measurement

Metrics Production

Testing Validation

Behavioral Health

BH Map Dashboard

Surveys

Medicaid BRFSS CAHPS Student Wellness Survey Physician Workforce BH Surveys

Clinical Quality Metrics Registry Data Requests and Access

DRC Data Extracts External Data Feeds FTP

OHPB Dashboard

Other

Policy & Legislative analysis, contract management, rules, data requests, committee support

OHA Metrics

PEBB/OEBB BH DOJ Block Grant

Other

Metrics policy analysis, emerging metrics QHOC, Quality Council,

OEI Analysis & Support Analysis

Utilizaton Legislative

Health Analytics Functional Chart

Definition of Demonstration Waiver 1115-

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• Experimental, pilot, or

demonstration projects for CMS-Medicaid

• Assist in promoting the
• bjectives of the

Medicaid program.

• Give states additional

flexibility to design and improve their programs in a budget neutral manner

Who and Why Evaluate the Waiver?

• CMS - Interim (Mid-term) Report and Summative

(Final) Report for Waiver

• Independent third party required
• Center for Health System Effectiveness (CHSE)
• John McConnell, Ph.D. a Health Economist

Director

• Recently presented findings of 2012-17

Evaluation at Health Policy Board Retreat

• Posted 180 page report to OHA website

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Evaluation Project = Scientific Model Metrics = CQI-PDSA Model

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Examples of Evaluation Project Scope + Actions Assess System Transformation

History Implementation Science Complex Adaptive Systems Theory Organizational Culture Patient Outcomes: Triple Aim Payment Reform Integration and Care Coordination Provider-Patient Relationship Patient Outcomes: Transitional

SYSTEM LEVEL

The relationship between the state health care system and the CCOs

OPERATIONAL LEVEL

The relationships among CCOs, providers, and clinic staff

PATIENT LEVEL

The relationship between the provider and patient, and impacts on patient health

COLLABORATIVE LEVEL

The relationships among each CCO’s partners and providers

• CCO Innovation and Structure - Does it work to

provide high quality, lower cost to Medicaid members?

• How do CCOs function and work with their

partners?

• What local innovations are working for payment

models or integrated care?

• Do CCO models work to improve patient

engagement, satisfaction and health outcomes?

Typical Evaluation-type QUESTIONS THEORETICAL LENS SCOPE

HEALTH CARE TRANSFORMATION AND CHANGE – A multi-year process

Evaluation Plan 2017-2022

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Medicaid Theory of Planned Action

• Theoretical Foundation for programs and

conceptual relationships

• Summary of all activities in the

Demonstration Waiver

• Moves from left to right starting with

ACTIONS of OHA and CCOs, LEVERS for transformation, GOALS, OUTCOMES and AIMS

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Quality Levers

• Lever 1: Emphasis on primary care through patient- centered

primary care homes (PCPCH)

• Lever 2: Implementing alternative payment methodologies
• Lever 3: Integrating physical, behavioral, and oral health care

structurally and in the model of care

• Lever 4: Increased efficiency in providing care through

administrative simplification that incorporates community-based and public health resources

• Lever 5: Implementation of health-related flexible services aimed
• Lever 6: Testing, accelerating and spreading effective delivery

system and payment innovations

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CCO relationship to Evaluation Plan- First Waiver 2012-17 Second Waiver 2017-2022

• Central in design to bend cost curve
• Still very innovative
• Basis for value-based payment plan
• (Incentive pool is a VBP)
• Promotes transformation in care

Toward health maintenance model Consideration of SDOH Integration of oral and behavioral health Spread of innovation

Key FINDINGS from Summative Evaluation Report

December 29, 2017

– Spending decreased compared to WA Medicaid, driven by decreased inpatient facility spending – Infrastructure changes provide a foundation for continued Improvement – Total ED visit rate and avoidable ED visit rates decreased – Quality measures improved in areas where improvements were incentivized – Most experience of care measures improved

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Lessons Learned

Savings achieved, but still work to be done…

• Tension between centralized/standardized vs.

home grown/customized

• Integration is challenging
• Desire to address social determinants of health vs.

regulatory realities, lack of specific options

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CHSE Recommendations

• Value and Pay for Performance
• Integration-

– Care Coordination and Behavioral Health

• Social Determinants of Health Focus –

– Logistical Details of Flexible Health Related Services

• Sustainable Cost Growth, i.e., prescription drug

costs

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Incentive Metrics a Major Finding in Final Report for 2012-17

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• Promotes health system integration
• Supports the six levers
• Focus of attention on key issues
• Promotes transformation
• Link to report:

http://www.oregon.gov/oha/HPA/ANALYTICS/ Evaluation%20docs/Summative%20Medicaid% 20Waiver%20Evaluation%20- %20Final%20Report.pdf

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Time for a break.

Program Structure Planning

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HPQMC

Develops Annual Measure Set Metrics & Scoring

Researches New Measures Determines Annual CCO Measure Sets & Benchmarks

Health Policy Board Technical Advisory Group

Metrics and Health System Transformation: Setting the Stage

Setting the Stage

Oregon Health Policy Board:

• Purpose: The policy-making and oversight body for the

Oregon Health Authority

• Drivers and guidance: HB2009 (2009)

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Setting the Stage (continued)

Health Plan Quality Metrics Committee:

• Purpose: Align health outcome and quality measures used for state

healthcare programs (SB440)

• Function or role: Establish a process for regular and ongoing

evaluation of measures selected

• Drivers and guidance: SB440 (2015)
• Vision: (Committee agreed, not outlined in SB440)
• Aligned measurement to promote optimum health and wellbeing for all

Oregonians.

• Mission: (Committee agreed, not outlined in SB440)
• Improving physical, behavioral and dental health for individuals and

communities through meaningful and timely quality measures to guide health care purchasing and value.

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Setting the Stage, HPQMC (continued)

• Measure selection criteria (see handout)
• Domains (Committee agreed, for categorizing measures

under review, not strategic priorities, may be revisited after April)

• HPQMC likely to revisit these domains in future, as meant as way to

categorize the measures they reviewed

• Access
• Acute Care
• Behavioral Health
• Chronic Illness Care
• Inpatient Care
• Maternity Care
• Oral Health
• Overuse / Waste
• Patient Experience

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Setting the Stage

Metrics and Scoring Committee:

• Purpose: Identify measures and benchmarks for CCOs. Language from

charter: The committee shall use a public process to identify objective

• utcome and quality measures [and benchmarks], including measures of
• utcome and quality for ambulatory care, inpatient care, chemical

dependency and mental health treatment, oral health care and all other health services provided by coordinated care organizations.

• Function or role: To select measures that incentivize continuous quality

improvement among CCOs.

• Drivers or guidance: SB1580 (2012), CMS Waiver
• Vision: -
• Mission: -

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Setting the Stage, Metrics & Scoring Metrics (continued)

• Measure Selection Criteria (see handout)
• Discussion questions on next slides
• Domains
• None.
• Discussion questions on next slides

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Discussion (1/2)

Overarching question: Using the strengths and experience of the Metrics and Scoring Committee, how does this committee envision the future and its role in metric development within the current framework? Supplementary questions:

• What is the fundamental purpose of the incentive program: Is it to measure

health care processes or health care outcomes? How / should this be reflected in the measure selection criteria / program framework?

• How important is a distribution of measures (across categories: access,

satisfaction, outcomes; alternatively or additionally across populations: children, adults, special needs populations)?

• And if important, should this/these be called out as the ‘formal M&S framework /

domains’?

• Are there any payment implications to such a change (desire to structure payment

around domains, etc)?

• What consideration do we give to cost in our quality metrics? One of the

primary purposes of CCOs is to reduce health care costs. How much of a priority should we give to those metrics that really save money?

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Discussion (2/2)

• Measure Selection Criteria
• How / do we integrate discussion from previous slide into the measure selection

criteria?

• What is the relationship between the M&S measure selection criteria and that from

the HPQMC? Do they need to align?

• How can we make this more useful moving forward? .
• Staff clarification: how use two tables?
• Domains
• None currently.
• How / do we integrate discussion from previous slides into whether the Committee

feels it needs a domain / framework structure?

• Should any M&S domain structure / framework align with the HPQMC? If so, how?

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Wrap-Up Next Meeting: March 16, 2018

• eClinical Quality Measures-palooza!