Data Workgroup February 7, 2019 Welcome, Meeting Purpose & - - PDF document

Data Workgroup

February 7, 2019

Welcome, Meeting Purpose & Introductions

Agenda

• SWACH updates
• Workgroup updates
• Review official pay for performance measure baseline results
• Update on monitoring data products

3

Action Items from Last Meeting

N/A

4

SWACH Updates

‐ Staffing ‐ Partner binding agreement process / status ‐ Dashboard

Workgroup Updates

Workgroup members share any data related updates from their organizations: new or updated data sources, data projects, new analyses, exciting news, etc

Official Pay for Performance (P4P) Measure Results

What’s new?

HCA has now provided official ACH 2017 baseline and 2019 targets for ACH Pay for Performance measures

Pay for Performance Measures (P4P)

• Calculated automatically by Health Care Authority
• Measure the region’s progress toward Medicaid transformation

goals

• Determine whether ACHs earn payment for transformation work

(which affects available funds for partner organizations)

• ACHs can receive partial credit (and earn partial funds)

Two Types of P4P Measures

Gap to Goal

Compare ACH baseline (2017) to an absolute benchmark (usually national Medicaid 90th percentile). ACHs must reduce gap by 10%.

Improvement over Self

No benchmark. ACHs must improve ~2% over their baseline performance (2017).

2019 Measures

Gap to Goal

• Antidepressant and asthma

medication management

• Child and adolescent access to

primary care

• Diabetes care

Improvement over Self

• Emergency department visits
• Mental health and SUD treatment

penetration

• Chronic and high‐dose opioid

prescriptions

• Homelessness
• Hospital readmissions (30 day)

Example

How to read the following slides

51.0% 36.0% 67.6% 54.3%

Measure 1 Measure 2

2017 BASELINE 2019 TARGET 2017 BASELINE 2019 TARGET

Integration Care Coordination Opioids Chronic Disease

Data Source:

Not all measures relate to all SWACH project areas Each measure has a baseline (2017) and a target (2019)

Emergency Department Utilization (“All Cause”)

The rate of Medicaid member visits to the Emergency Department (all ages), including visits related to mental health and chemical dependency, reported per 1,000 member months

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

← Lower is beer

28.01% 52.71% 41.96% 28.56% 53.73% 42.77% Age 0‐17 Age 18‐64 Age 65+

2017 BASELINE 2019 TARGET

54.43% 39.98% 55.35% 40.89% Acute Continuation

BASE TARGET

Antidepressant Medication Management

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 12 weeks (acute) and 6 months (continuation)

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

 Higher is better 2017 BASELINE 2019 TARGET

54% 52% 56%

Clark County Skamania County Klickitat County

Antidepressant Medication Management – Acute, By County

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 12 weeks (acute)

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

2017 Baseline Higher is better

2019 Target: 55%

Antidepressant Medication Management – Continuation, By County

The percent of Medicaid members ages 18+ with a diagnosis of major depression who were newly treated with antidepressant medication and remained on for 6 months (continuation)

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

2017 BASELINE 2019 TARGET 2017 Baseline Higher is better

2019 Target: 41%

40% 42% 44%

Clark County Skamania County Klickitat County

Child and Adolescent Access to Primary Care

The percent of Medicaid children who had a visit with a primary care provider in the measurement period

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

94.28% 82.25% 87.48% 87.23% 94.64% 84.25% 88.34% 88.11% Age 12 ‐ 24 months Age 2 ‐ 6 years Age 7 ‐ 11 years Age 12 ‐ 19 years

2017 BASELINE 2019 TARGET  Higher is better

Comprehensive Diabetes Care

The percent of adults with diabetes who received recommended preventive services in the measurement period

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

83.45% 87.61% 82.12% 86.79%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00%

HbA1c Testing Medical Attention for Nephropathy

2017 BASELINE 2019 TARGET  Higher is better

Medication Management for People with Asthma

The percent of Medicaid members age 5‐64 who were identified with persistent asthma and dispensed appropriate medications that they remained on during the measurement period (with 75% compliance).

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

38.09% 36.77% Compliance 75%

2017 BASELINE 2019 TARGET  Higher is better

Mental Health Treatment Penetration

The percent of Medicaid members with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

12.90% 47.1% 65.7% 13.15% 48.0% 66.9% Ages 65+ Ages 18‐64 Ages 6‐17

2017 BASELINE 2019 TARGET  Higher is better

Mental Health Treatment Penetration – By County

66% 70% 62%

Clark County Skamania County Klickitat County Ages 6‐17

The percent of Medicaid members age 6‐17 with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Higher is better

2019 Target: 67%

2017 Baseline

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

47% 45% 47%

Clark County Skamania County Klickitat County Ages 18‐64

Mental Health Treatment Penetration – By County

The percent of Medicaid members age 6‐17 with a mental health treatment need who received at least one qualifying service during the measurement period (broad).

Higher is better

2019 Target: 48%

2017 Baseline

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Chronic High-Dose Opioid Therapy

The percent of Medicaid members age 18‐64 who were prescribed chronic opioid therapy in high Morphine Equivalent Dosage (MED) in a quarter.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

26.76% 13.90% 27.28% 14.17% >50 mg MED in a quarter >90 mg MED in a quarter

2017 BASELINE 2019 TARGET ← Lower is beer

27% 34% 26%

Clark County Skamania County Klickitat County

>50 mg MED

Lower is better

2019 Target: 27%

2017 Baseline

Chronic High-Dose Opioid Therapy, By County

The percent of Medicaid members age 18‐64 who were prescribed chronic opioid therapy in >50 mg Morphine Equivalent Dosage (MED) in a quarter.

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

15% 16% 10%

Clark County Skamania County Klickitat County

>90 mg MED

Lower is better

2019 Target: 14%

2017 Baseline

Chronic High-Dose Opioid Therapy, By County

The percent of Medicaid members age 18‐64 who were prescribed chronic opioid therapy in >90 mg Morphine Equivalent Dosage (MED) in a quarter.

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Concurrent Opioids & Sedatives

The percent of Medicaid members age 18‐64 prescribed opioids and a concurrent sedative prescription, among beneficiaries prescribed chronic opioids.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

21.05% 21.46% Concurrent Opioid and Sedative Prescriptions

2017 BASELINE 2019 TARGET ← Lower is beer

22% 14% 22% Clark County Skamania County Klickitat County

Lower is better

2019 Target: 21%

2017 Baseline

Concurrent Opioids & Sedatives, by County

The percent of Medicaid members age 18‐64 prescribed opioids and a concurrent sedative prescription, among beneficiaries prescribed chronic opioids.

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Percent Homeless

The percent of Medicaid members who were homeless in at least one month of the measurement period.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

0.46% 3.67% 1.96% 0.47% 3.74% 1.99% Ages 0‐17 Ages 18‐64 Ages 65+

2017 BASELINE 2019 TARGET ← Lower is beer

Plan All-Cause Readmission

The percentage of acute inpatient stays for Medicaid members ages 18‐64 that were followed by an unplanned acute readmission within 30 days.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

10.28% 10.47% Patients readmitted within 30 days

2017 BASELINE 2019 TARGET ← Lower is beer

Substance Use Disorder Treatment Penetration

The percent of Medicaid members age 12+ with a substance use disorder treatment need who received substance use disorder treatment during the measurement period.

Integration Care Coordination Opioids Chronic Disease

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

34.4% 32.4% 35.0% 33.0% Ages 12‐17 Ages 18‐64

2017 BASELINE 2019 TARGET  Higher is better

33% 30% 24% Clark County Klickitat County Skamania County

Substance Use Disorder Treatment Penetration, by County

The percent of Medicaid members age 18‐64 with a substance use disorder (SUD) treatment need who received SUD treatment during the measurement period.

Higher is better

2019 Target: 33%

2017 Baseline

Data Source: DSRIP Pay‐for‐Performance Metrics, Baseline Year 1 (CY2017) Metric Results and Improvement Targets (CY 2019), Washington State Health Care Authority

Monitoring Data Products Update

Vision for data products

Single location for SWACH to get the data and information needed to track progress. User‐friendly, interactive tools that make complex data from multiple sources easy to understand. Tailored to SWACH needs and priorities.

Access to Data products

SWACH will have it’s own landing page to access the data products, with logo / custom colors, etc SWACH Front Page Landing pages are publicly available – anyone with the link can view.

ACH Staff Stakeholders General Public

Dashboard Suite Title ACH Name Logo

This is the landing page – the first thing a user sees. Intro/ explanatory text will go here. Report icons are below, and user scan click to view the report or set of reports in that category.

Population Provider Click on the icons/ links below to view reports. Pay‐for‐ Performance Partner Reporting Cost & Utilization Quality Project/ Program Population Health

Some reports will be publicly available – anyone (staff, stakeholders, general public) can access

TBD

Dashboard Suite Title ACH Name Logo

Population Provider Click on the icons/ links below to view reports. Pay‐for‐ Performance Partner Reporting Cost & Utilization Quality Project/ Program Population Health

Some reports will include sensitive information (e.g. Category 2 data) and will not be publicly available. *These reports will have some indication (text, icon, separate link, etc) that they are restricted to the authorized data users that each ACH has identified

TBD

This is the landing page – the first thing a user sees. Intro/ explanatory text will go here. Report icons are below, and user scan click to view the report or set of reports in that category.

Partner Reporting*

When someone tries to access a sensitive report, they will be asked to log‐in

Log‐in

Only authorized data users will be able to log‐in. These pre‐approved staff members will have access to Category 2, sensitive data, including aggregate, unsuppressed data (i.e. small numbers) and sensitive data, such as partner performance.

Staff Partner Reporting*

Log‐ in

General Public

√

Draft Provider Reports

Report Description Data Source Data Display Filters

Medicaid Providers Count & percent of providers serving Medicaid members in the ACH region APCD ‐ Chart ‐ Trend ‐ Table ‐ County ‐ Service Type (Primary care, dental, BH*) ‐ Duals/ Non‐Duals Top Provider Organizations by Volume Volume, percent, and case mix of members served for highest volume provider organizations serving members in the ACH region APCD ‐ Chart ‐ Trend ‐ Map? ‐ Table ‐ Service Type ‐ Payer Type (Medicaid, Medicare Adv, Commercial) ‐ Geography (county, zip?) ‐ Population Flags? Partnering Provider Volume Volume, percent, and case mix of members served for ACH partnering provider organizations APCD ‐ Chart ‐ Trend ‐ Map? ‐ Table ‐ Service Type ‐ Payer Type ‐ Geography (county, zip?) ‐ Population Flags? Practice Attribution Count and percent of members attributed to practice/ clinic for highest volume practices APCD ‐ Chart ‐ Map? ‐ Table ‐ Payer Type ‐ Geography ‐ Population flags?

Provider Reports Logo ACH Name

Medicaid Providers

Select report

Provider Volume Partnering Provider Volume Practice Attribution

Select data display

Chart Trend

Select filters

Geography Service Type Table Documentation Export Data

Notes:

‐ Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. ‐ Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. PDF/ Image or Excel file Duals Hovering over report title displays pop up with description

• f report

Links to information about data sources and methodology Visual display of data for key measures User can filter by various dimensions. User can select type

• f data

display Key contextual information, such as data source and time period.

Provider Reports Logo ACH Name

Medicaid Providers

Select report

Provider Volume Partnering Provider Volume Practice Attribution

Select data display

Chart Trend

Select filters

Table

Notes:

‐ Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. ‐ Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

2014 2015 2016 2017 2018 2019 2020 2021

Documentatio n Export Data Geography Service Type Duals

Provider Reports Logo ACH Name

Medicaid Providers

Select report

Provider Volume Partnering Provider Volume Practice Attribution

Select data display

Chart Trend

Select filters

Table

Notes:

‐ Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. ‐ Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. State ACH County1 County2 County3 Measure # # # # # % % % % % Measure # # # # # % % % % % Measure # # # # # % % % % % Documentatio n Export Data Geography Service Type Duals

Provider Reports Logo ACH Name

Medicaid Providers

Select report

Provider Volume Partnering Provider Volume Practice Attribution

Select data display

Chart Trend Map

Select filters

Service Type Payer Type Table

Notes:

‐ Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. ‐ Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Provider Count Percent Case Mix Provider1 # % Provider2 # % Provider3 # % Provider4 # % Provider5 # % Provider6 # % Provider7 # % Provider8 # % Provider9 # % Provider10 # % Provider11 # % Provider12 # % Population Flags Geography Documentatio n Export Data Display top 20‐ ish providers.

40% 25% 35%

Filters may phase in over time

Draft Population Reports

Report Description Data Source Data Display Filters

Demographics

• Total #
• Payer type
• Gender
• Age groups: 0‐17, 18‐64, 65+
• Race/Ethnicity

APCD

• Table
• Chart
• Map
• Trend

‐ Geography ‐ Payer type ‐ Population flags ‐ Diagnoses Population Flags

• Total #
• High ED utilizers
• No utilization
• Coverage spans: 7+, 11+ months
• Target population: TBD
• High cost TBD

APCD

• Table
• Chart
• Map
• Trend

‐ Geography ‐ Payer type ‐ Demographics ‐ Diagnoses Diagnoses & Conditions

• Total #
• Chronic conditions: diabetes,

asthma, COPD, hypertension,

• Other conditions TBD

APCD

• Table
• Chart
• Map
• Trend

‐ Geography ‐ Payer type ‐ Population Flags ‐ Demographics Enrollment

• Total Medicaid enrollment #
• FFS, MCO, Tribal enrollment
• Eligibility categories
• Benefit types

APCD

• Table
• Chart
• Trend

‐ County / ACH

Draft P4P Reports

Report Description Data Source Data Display Filters

Metric Performance

• ACH baseline, current performance,

targets, and benchmark for projects

• Statewide average
• Highest / lowest performing region
• Number needed to treat

HCA HW Dashboard files

• Table
• Chart
• Trend?

‐ Geography Estimated Achievement Value Estimated Achievement Value (AV) at current performance by project and total

• Table
• Chart

N/A High Performance Pool

• ACH baseline, current performance
• Statewide average
• Highest / lowest performing region

RDA measure decomposition duals files?

• Table
• Chart

TBD P4P for Target Populations A subset of the P4P measures will be calculated for target populations TBD

• Table
• Chart
• Map
• Trend

Draft Value Based Payment Reports

Report Description Data Source Data Display Filters

Payment Type Percent of payments under different arrangements: capitation, FFS, percent

• f charges, DRG, other

APCD

• Table
• Chart
• Map?
• Trend

‐ Geography ‐ Payer Type Member Payment Type Number and percent of members under different payment arrangements APCD

• Table
• Chart
• Map?
• Trend

‐ Geography ‐ Payer Type ‐ Population flags / diagnoses ‐ Demographics Value‐Based Payments Percent of VBP payments by HCP‐LAN categories; statewide VBP targets HCA VBP surveys

• Table
• Chart

‐ Geography

Wrap Up

• Next Meeting: April 4th
• Review action items

46