Data Workgroup September 6, 2018 Welcome & Introductions - - PowerPoint PPT Presentation

Data Workgroup

September 6, 2018

Welcome & Introductions

Agenda

• Agenda Review / Action Items
• SWACH Updates
• Workgroup Updates
• Revised Measurement Guide
• Monitoring Data Products

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Action Items from Last Meeting

Sarah / David H Revise draft charter to incorporate discussed changes Sarah Update meeting appointments to reflect frequency changes Daniel Ask Beacon about a behavioral health representative for group DLT members Send additional thoughts about assessment findings to staff David D / Corey Ask internally about any MCO initiatives to increase / encourage MAT Staff Distribute notes / slides

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SWACH Updates

• New staff / leadership
• Non-clinical partner RFI
• Clinical Transformation Plan updates
• Pathways environmental scan (Klickitat, Skamania)

Workgroup Updates

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

Revised Measurement Guide

Background

• Revised measurement guide released Aug 2018
• Guide describes measures, timelines, and

payment mechanisms for ACHs.

https://www.hca.wa.gov/assets/program/mtp-measurement-guide.pdf

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Pay for Performance

Pay for Performance (P4P) Measures

• ACHs will earn a portion of their funding based on their

performance (aggregate performance for the region) on the P4P measures beginning in Year 3 (2019).

• HCA is responsible for calculating ACH performance on P4P

measures; the state will not require any additional reporting from partners for these measures.

• HCA will calculate these measures at the ACH level, not at the

provider / practice level.

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What’s branding?

ACH Pay for Performance (P4P) Measures

Measure

Integration Care Coordination Opioids Chronic Disease State MCO

All-Cause Emergency Department (ED) Visits X X X X X Acute Hospital Utilization X X X X Follow up after ED visit for mental health X X Follow up after hospitalization for mental illness X X Follow-up after ED visit for alcohol or drug dependence X X Mental health treatment penetration (broad) X X X X X Plan All-Cause Readmissions X X X Substance use disorder treatment penetration X X X X Child and Adolescents’ Access to Primary Care Practitioners X X

What’s branding?

ACH Pay for Performance (P4P) Measures

Measure

Integration Care Coordination Opioids Chronic Disease State MCO

Comprehensive Diabetes Care: Eye Exam performed X X Comprehensive Diabetes Care: HbA1c testing X X Comprehensive Diabetes Care: Medical Attention for Nephropathy X X Medication Management for People with Asthma (5-64 years) X X X X Antidepressant Medication Management X X X Patients on high-dose chronic opioid therapy X Patients with concurrent opioids/sedatives prescriptions X Substance use disorder treatment penetration (opioids) X Statin Therapy for Patients with Cardiovascular Disease X Percent homeless (narrow) X

Measure Production

ACH P4P measures will have multiple criteria applied. This means that ACH P4P measure results will likely be different from other measure production (i.e. MCOs, APCD, Community Checkup, etc).

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Measure Production: Chlamydia Screening

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1) All Washington State Medicaid beneficiaries. 2) Apply metric specific criteria: women, ages 16-24, who are sexually active and who are not receiving hospice care. 3) Apply general eligible population criteria: include Medicaid beneficiaries with comprehensive medical benefits or family planning only benefits. Exclude duals and those with primary insurance other than Medicaid. 4) Metric population: total possible metric population after criteria applied. 5) Regional attribution: attribute a beneficiary to a single ACH region based on their address during the measurement period (11 of 12 months, or 7 of 12 months)

ACH Improvement Targets

• To earn incentive dollars for P4P measures, ACHs must

meet annual improvement targets.

• Improvement targets are calculated in two ways:

– Gap to Goal – Improvement Over Self

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Gap to Goal

Calculated based on the difference between ACH baseline performance and an absolute benchmark (national 90th percentile for Medicaid). ACHs must close the gap by 10%.

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Improvement Over Self

Calculated based on 1.9% improvement over ACH baseline performance.

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Official Baseline and Targets

HCA will release ACH official baseline performance and improvement targets for 2019 in October. The first baseline performance period is CY 2017. Baseline performance and improvement targets will be reset for each of the three P4P years (2019, 2020, 2021).

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ACHs can earn partial credit

Even if an ACH does not meet its improvement target, it can earn a portion of the incentive dollars. Partial improvement will be translated into “Achievement Values” (AV) to determine incentives earned.

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High Performance Incentives

If ACHs do not earn all of their P4P incentives based on meeting improvement targets, the remaining dollars can still be earned based on performance on 9 metrics. Available funds are adjusted based on # of Medicaid lives. The high performance metrics include duals.

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High Performance Metrics

All-cause ED visits Antidepressant medication management Medication management for people w/asthma Mental health treatment penetration Percent arrested Percent homeless Plan all-cause readmission Substance use disorder treatment penetration Well-child visits in 3-6 years of life

Current Performance on P4P Measures

Not official baseline

Measure Date SWACH Performance Statewide Performance Relative to State

All-cause Emergency Department Utilization (per 1,000 member months) * Q3 2017 39.4 48.0 Antidepressant Medication Management – Acute Q3 2017 51% 50% Antidepressant Medicaid Management – Continuation Q3 2017 36% 34% Child and Adolescent Access to Primary Care (12-24 months) Q3 2017 89% 93% Child and Adolescent Access to Primary Care (2-6 years) Q3 2017 81% 85% Child and Adolescent Access to Primary Care (7-11 years) Q3 2017 87% 90% Child and Adolescent Access to Primary Care (12-19 years) Q3 2017 86% 90% Comprehensive Diabetes Care: Eye Exam Q3 2017 39% 33% Comprehensive Diabetes Care: HbA1c Testing Q3 2017 83% 84% Comprehensive Diabetes Care: Medical Attention for Nephropathy Q3 2017 86% 86% Follow up after Discharge from ED for Alcohol or Other Drug Dependence (7 day) Q3 2017 34% 24% Follow up after Discharge from ED for Alcohol or Other Drug Dependence (30 day) Q3 2017 43% 32% Follow up after Discharge from ED for Mental Health (7 day) Q3 2017 62% 61% Follow up after Discharge from ED for Mental Health (30 day) Q3 2017 75% 72% Follow up after Hospitalization for Mental Health (7 day) Q3 2017 86% 87% Follow up after Hospitalization for Mental Health (30 day) Q3 2017 91% 91% Inpatient Hospital Utilization (per 1,000 member months) * Q3 2017 65.3 67.1

Pay for Performance (P4P) Measure Dashboard

Measurement Period: Oct 2016 – Sept 2017

Legend Data Sources

Data sources used include: Healthier Washington Data Dashboard + RDA Measure Decomposition Reports SWACH performance is at or above statewide SWACH performance is below statewide SWACH is the lowest performing ACH region

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Aug 2018

Improvement over Self Gap to Goal *lower rate indicates better performance

Legend About P4P Measures

The first year ACHs will be held accountable for P4P measures is CY 2019. Performance in CY 2019 will be compared to baseline (CY 2017). Official ACH baseline performance will be calculated for CY 2017; the state intends to release baseline results in October 2018. Official improvement targets and benchmarks for measures will also be released in October 2018. SWACH performance reported here is preliminary. Benchmarks for gap to goal measures will likely be the national Medicaid 90th percentile; ACHs must close the gap between baseline and benchmarks by 10%. Targets for improvement over self measures will be based on 1.9% improvement from baseline. Future updates of the P4P Measure Dashboard will include official baseline and benchmarks / improvement targets. The P4P Measure Dashboard will be updated quarterly where possible; however, some measures are only available annually or semi-annually. SWACH performance is at or above statewide SWACH performance is below statewide SWACH is the lowest performing ACH region

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Aug 2018

Measure Date SWACH Performance Statewide Performance Relative to State

Medication Management for People with Asthma Q3 2017 32% 31% Mental Health Treatment Penetration Q3 2017 47% 46% Percent Homeless (ages 18-64) * Q3 2017 4% 5% Plan All-Cause Readmission* Q3 2017 11% 14% Substance Use Disorder Treatment Penetration (ages 18-64) Q3 2017 31% 29% Patients on High Dose Chronic Opioid Therapy Data for these measures not yet available Patients with Concurrent Opioid and Sedative Prescriptions Statin Therapy for Patients with Cardiovascular Disease Q3 2017 80% 78% Substance Use Disorder Treatment Penetration (Opioids) Q3 2017 36% 46% Improvement over Self Gap to Goal

*lower rate indicates better performance

Pay for Performance (P4P) Measure Dashboard

Measurement Period: Oct 2016 – Sept 2017

Pay for Reporting

Pay for Reporting (P4R)

• ACHs earn incentive payments for successfully completing

and reporting on project planning and implementation milestones (e.g. submitting Project Plan, Semi-Annual Reports, etc).

• ACHs will also earn incentive payments for ensuring complete

and timely reporting of Pay for Reporting measures to support project monitoring and evaluation.

– Unlike P4P measures, P4R measures require partner reporting

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P4R Measures

• Measures are only applicable for partners who are participating in specific projects

(integration, opioids).

• Measures are specific to partnering practices/clinics, and community-based
• rganizations.
• ACHs must collect and report these measures to HCA twice / year. ACHs have

flexibility in how they collect the information.

• HCA may follow up with selected partners to learn more about their process through

structured interviews. Each P4R measure has potential follow-up questions.

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P4R Measures for Integration

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Practice/Clinic Questions Response Format

Complete the Maine Health Access Foundation (MeHAF) site self-assessment tool. Submit complete tool with all ratings

Community Based Organization Questions Response Format

N/A

P4R Measures for Opioids

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Practice/Clinic Questions Response Format (select all that apply)

Do providers follow [specific] opioid prescribing guidelines?

• AMDG guidelines / Washington State prescribing guidelines
• Bree Collaborative guidelines
• CDC guidelines
• None of the above

What features does the site’s clinical decision support for opioid prescribing include?

• Integrated MED calculator
• Links to opioid prescribing registries or PDMPs
• Automatic flags for co-prescriptions of benzos
• None of the above

What protocols are in place to provide a pathway for patients with opioid use disorder to be evaluated for behavioral health interventions

• Screening and treatment for depression/anxiety occurs on site
• Screening for depression/anxiety occur on site, patients referred to treatment
• Contracting with providers who offer these services
• Formalized referral relationship with providers who offer these services
• Informal referral relationship with providers who offer these services
• None of the above

What protocols are in place to provide a pathway for all patients with opioid use disorder to be evaluated for medication-assisted treatment (MAT)

• Medications are provided on site
• Contracting with providers who offer these services
• Formalized referral relationship with providers who offer these services
• Informal referral relationship with providers who offer these services
• None of the above

P4R Measures for Opioids

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Emergency Department Questions Response Format (select all that apply)

Does the ED site have protocols in place to initiate Medication Assisted Treatment (MAT) and offer take- home naloxone for individuals seen for opioid

• verdose?
• MAT initiation
• Take-home naloxone
• Our ED does not offer these services
• Not applicable. Our site is not an ED.

P4R Measures for Opioids

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Community Based Organization Questions Response Format (drop down menu)

Does the CBO site have protocols in place to refer people with opioid use disorders to providers of medication-assisted treatment

• Yes
• No

Does the CBO site refer people with opioid use disorders for psychosocial care?

• Yes
• No

Does your site actively refer patients with opioid use disorder to a Hub & Spoke network or Opioid Treatment Network, where both medication and behavioral health treatments are available?

• Yes, via warm handoff
• Yes, via providing information
• No, we provide these services on site
• No , we do not refer for another reason

Did your CBO receive technical assistance to organize

• r expand a syringe exchange program, or to learn

about locally available access to clean syringes?

• Yes, to organize and expand
• Yes, to learn about access
• No, we did not receive technical assistance

Does your CBO provide referral information for clients interested in testing or treatment for Hep C and HIV?

• Yes, via warm handoff
• Yes, via providing information
• No, we provide these services on site
• No, we do not refer for another reason

Questions / Discussion

Monitoring Data Product(s)

What is a monitoring data product?

• A monitoring data product is a report, or workbook,
• r dashboard tool that will support SWACH’s efforts

to monitor project implementation and progress towards goals.

• Monitoring will need to occur at both partner and

ACH levels

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Monitoring vs Evaluation

Monitoring

• Routine activity – happens

throughout implementation

• Looks at what is happening and

how it is happening (i.e. program served 10 people this week)

• Supports more real-time decision

making, quality improvement, etc

Evaluation

• Occasional activity – may look at entire

project at the end*

• Draws conclusions about effectiveness or

impact (i.e. people who completed program had better outcomes)

• May inform future plans, usually takes time

before results are available*

*Vastly oversimplified, ignoring development or formative eval

Monitoring data is often used for evaluation 32

What we mean when we talk about measures…

Measures Description Determined by Reported by

Pay for Performance (P4P) SWACH level performance measures with annual improvement targets for DY 3-5. ACH receives payment for meeting targets. HCA HCA Pay for Reporting (P4R) Semi-annual process measures. ACH receives payments for submitting reports to HCA. HCA Partners -> SWACH ACH Indicators Additional outcome and performance measures that are important to the region. May be health system focused or population health / community focused (e.g. opioid deaths) SWACH TBD Partner Indicators Additional process or outcome measures that SWACH has determined partners should report on to monitor their progress. May be informed by Transformation Plans. SWACH Partners

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SWACH’s monitoring data product needs to…

• Track and report regional performance on P4P measures and other ACH indicators
• Track and report partner performance on P4R measures and other partner indicators
• Support SWACH’s reporting needs (to Board, to HCA, etc)
• Report regional performance on key community health / population health priorities
• Help identify barriers to implementation and improvement
• Help identified opportunities to scale and spread projects
• Support shared learning
• Support funds flow
• Collect data that may be useful for evaluation

Does anything seem missing from the list?

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Or, another way to think about it…

SWACH would like information about these things ↓ In order to do these things… Inform Funds Flow Internal planning Provide TA Report to HCA Report to Board / RHIP Report to public / community Support evaluation Implementation and progress of Transformation Plans       Progress on regional priority areas (whole person care, equity)      Progress (interim) on P4P measures or proxy measures    Progress toward VBP adoption   Required P4R measures   Other potential use cases?

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SWACH will use various data sources to support proposed monitoring data products

Partner & Program Reporting

• S

t at e P4R Measures

• ACH indicat ors / Part ner indicat ors
• Pat hways HUB (CCS

Plat form)

Other Existing Data Sources

• Claims & enrollment dat a (APCD, HCA)
• HCA and DS

HS dat a product s

• Public healt h dat a (survey, regist ry,

vit al records, et c)

• Hospit al, delivery syst em, & CBO (EDIE)

Other New Data Sources TBD

May include new primary dat a collect ion

ACH Internal Monitoring Dashboard/Workbook Community Dashboard Ad Hoc & Supplemental Reports

• e.g. Hot -spotting
• e.g. Answer specific questions

To CORE for dat a aggregation & analysis

HCA Semi-annual reporting

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Proposed Monitoring Data Product: ACH Internal Dashboard / Workbook

• Excel workbook or Tableau online report with different sections
• Intended primarily for ACH internal use

– Some sections set up to populate HCA reporting templates – Will help support quality improvement, technical assistance to partners

• Refreshed quarterly or semi-annually

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Proposed Monitoring Data Product: ACH Internal Dashboard / Workbook

Proposed Sections Description P4P Latest available official data for P4P measures at the ACH level. Some breakouts (county, key demographics, etc). Some indication of distance to target, and trend. P4R Latest available official P4R measure data at ACH level (breakouts TBD). ACH indicators Additional indicators that SWACH selected for the region (breakouts TBD). Something related to tribes has been suggested – this section or its own TBD Partner indicators Additional indicators that SWACH selected for partner reporting. Could include things like tracking project participation, or funds flow over time. Population / enrollment Medicaid enrollment (by county, key demographics, etc); MCO enrollment.

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Proposed Monitoring Data Product: ACH Internal Dashboard / Workbook

Are these the right sections? Should other sections be included? What kinds of things would the Data Workgroup want to be monitoring within these sections?

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Proposed Monitoring Data Product: Community Dashboard

• Excel workbook or Tableau
• nline report designed for

public audience

• Refreshed at least

annually, more frequently depending on data availability

Community Dashboard Intent

• High level communication of SWACH priorities and vision – NOT

used for quality improvement or accountability

• May be broader than Medicaid, focus on the entire community
• May be broader than health system and ACH P4P / P4R measures,

focus more on population health and social determinants of health

• Audience: community partners, stakeholders, Board, RHIP, etc.
• Data is presented at the ACH or County level, not partner level

County level reporting to support Community Voices Councils

• Data is compared to the state or other benchmark where possible
• Avoid duplication with other similar reports (e.g. public health)

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Proposed Monitoring Data Product: Community Dashboard

Does this seem like the right direction? Concerns? Are there similar reports or efforts that should be reviewed to avoid duplication? What kinds of things would the Data Workgroup suggest including in the community dashboard (given what you know about SWACH’s projects and strategic framework)?

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Next Steps

Timeframe Milestones

Sept – Oct Identify ACH and partner indicators Sept – Nov Data Workgroup and other stakeholder review of selected indicators Nov Final decisions about initial set of ACH and partner indicators: Which indicators, who reports what, and how often Jan – Feb 2019 Build partner reporting tools TBD March - April Test partner reporting tools March - April First ACH internal dashboard

Review SWACH’s project plan, strategic framework, and tactics / measures submitted by clinical partners in their transformation plans to develop a short list of potential ACH indicators. Review short list of ACH indicators; suggest additional measures (potential Data Workgroup homework before end of September) Compile feedback, review for feasibility. SWACH approval of short list in October. 42

Wrap Up

• Next Meeting: November 6th

Confirm Oct 1 cancellation

• Review action items

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