Metrics & Scoring Committee February 16, 2018 HEALTH POLICY & ANALYTICS Office of Health Analytics
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 2
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 9 th . • Evidence-based obesity measure – Project plan complete, to be shared with Committee – Kick off meeting tentatively scheduled to occur in April 3
Vice-Chair elections 4
Public testimony HEALTH POLICY & ANALYTICS Office of Health Analytics 5
Health Plan Quality Metrics Committee (1/2) • Met February 8 th 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 6
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 7
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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 13
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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 of ED visits. OFFICE OF HEALTH ANALYICS Health Policy and Analytics 28
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Demonstration Waiver 1115 Program Evaluation February 16, 2018 Summary by Valerie T Stewart, Ph.D. Metrics and Evaluation Manager HEALTH POLICY & ANALYTICS Office of Health Analytics
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 31
Agency Overview 32
Health Analytics Functional Chart Metrics Research & Data Finance & Cost Hospitals & CCO Metrics Workforce Clinical Quality Facilities CORE Dashboard OHPB Dashboard SHEW Metrics Committee Metrics Registry Licensing data Medicaid Expansion Metrics TAG Physician Workforce Inpatient Outpatient estimates Databank Community Benefit Audited Financial Health Plan Hospital Metrics Evaluation APAC Coverage & Access Capital Projects ASC Quality Metrics (HTPP) (APAC dataset) Price SIM (SB 440) Hospital Committee DCBS Cycle III OHIS Transparency Waiver APAC TAG Hospital TAG Uninsurance estimates Data Collection ACS/NHIS Reporting OHA Metrics Other PEBB/OEBB BH DOJ Metrics policy analysis, emerging metrics QHOC, Quality Other Block Grant Council, Policy & Legislative analysis, contract management, rules, data requests, committee support Data Integration Program Analysis & Measurement OHP/Medicaid Data Gov, Privacy Transparency & Behavioral Health Surveys Data Systems & Support & Security Reporting BH Map Dashboard Infrastructure Reports and Data Hub? Medicaid BRFSS dashboards ISPO/DOJ Liaison CAHPS Consumer Price Data Warehousing HAL Analyses Student Wellness Info (SB 900)? Server Survey Data Quality Physician Workforce Metrics Data Requests Data Strategy & Data Documentation BH Surveys OEI Analysis & Production and Access Integration Sharepoint, BI Support OIS Liaison Testing DRC Cross‐ agency: ASU, Validation Data Extracts External ICS, EDIE, Analysis Data Feeds FTP Provider Directory, Utilizaton Public Health Legislative
Definition of Demonstration Waiver 1115- • Experimental, pilot, or demonstration projects for CMS-Medicaid • Assist in promoting the objectives of the Medicaid program. • Give states additional flexibility to design and improve their programs in a budget neutral manner 34
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 35
Evaluation Project = Scientific Model Metrics = CQI-PDSA Model 36
Examples of Evaluation Project Scope + Actions Assess System Transformation HEALTH CARE TRANSFORMATION AND CHANGE – A multi-year process Typical Evaluation-type QUESTIONS SCOPE THEORETICAL LENS • CCO Innovation and Structure - Does it work to History SYSTEM LEVEL The relationship between provide high quality, lower cost to Medicaid the state health care system Implementation members? and the CCOs Science COLLABORATIVE Complex Adaptive • How do CCOs function and work with their Systems Theory LEVEL The relationships among partners? Organizational each CCO’s partners and Culture providers OPERATIONAL • What local innovations are working for payment Payment Reform LEVEL The relationships among models or integrated care? Integration and Care CCOs, providers, and clinic Coordination staff PATIENT LEVEL Provider-Patient The relationship between Relationship • Do CCO models work to improve patient the provider and patient, Patient Outcomes: and impacts on patient Transitional engagement, satisfaction and health outcomes? health Patient Outcomes: Triple Aim
Evaluation Plan 2017-2022 38
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 39
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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 HEALTH POLICY & ANALYTICS 41
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