In In-Person Meeting January 10-11, 2019 Welcome 2 MAC Scorecard - - PowerPoint PPT Presentation

Medicaid and CHIP (M (MAC) ) Scorecard Committee In In-Person Meeting

January 10-11, 2019

Welcome

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MAC Scorecard NQF Project Team

▪ Debjani Mukherjee, Senior Director ▪ Ashlie Wilbon, Senior Director ▪ Shaconna Gorham, Senior Project Manager ▪ Miranda Kuwahara, Project Manager ▪ Jordan Hirsch, Project Analyst

3

Welcome

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▪ Restrooms

 Exit main conference area, past elevators, on right.

▪ Breaks

 10:40am – 15 minutes  12:45pm – Lunch provided by NQF

▪ Laptops and cell phones

 Wi-Fi network

» User name: guest » Password: NQFguest

 Please mute your cell phone during the meeting

▪ Public comment period

 Dedicated times for public comment  Comment via chat box at any time and comments will be shared

during dedicated times

Review of Meeting Objectives

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Meeting Objectives

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Identify priority measure gaps and gap areas Identify measures for potential addition that address identified gaps or measures for removal Consider states’ experiences implementing the Medicaid Child and Adult Core Set measures

Introductions of Committee Members and Disclosures of Interest

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MAC Scorecard Committee Membership

Committee Chairs (voting)

Harold Pincus, MD Richard Antonelli, MD

Organizational Members (voting) Organizational Representative

Aetna Medicaid Stephanie A. Whyte MD, MBA, CHCQM, CHIE American Association on Health and Disability Clarke Ross, DPA American Association of Nurse Practitioners (AANP) Sue Kendig, JD, WHNP-BC, FAAPN American Nurses Association (ANA) Rhonda Anderson, RN American Occupational Therapy Association Joy Hammel, PhD Anthem Indiana Medicaid Carla Zachodni, RN, MBA, CPHQ Association for Community Affiliated Plans (ACAP) Enrique Martinez-Vidal, MPP Children's Hospital Association (CHA) Sally Turbyville, DRPH, MS, MA Human Services Research Institute Julie Bershadsky, PhD Intermountain Health Josh Romney, MD National Association of Medicaid Directors (NAMD) Elizabeth Matney Sarah Brooks National Association of Pediatric Nurse Practitioners (NAPNAP) Shayna Dahan, BSN, RN, MSN, CPNP, PMHS National Partnership for Women & Families Carol Sakala, PhD, MSPH Ohio Department of Medicaid Mary Applegate, MD 8

MAC Scorecard Committee Membership

9

Individual Subject Matter Experts (voting)

Kim Elliott, PhD, CPHQ SreyRam Kuy, MD, MHS, FACS Julia Logan, MD Lisa Patton, PhD Judy Zerzan, MD Marissa Schlaifer, RPh, MS Kamala Allen, MHS David Einzig, MD Amy Houtrow, MD, PhD, MPH David Kelley, MD, MPA Stephen Lawless, BS, MD, MBA, FAAP, FCCM, FSMB Jill Morrow-Gorton, MD, MBA Elisabeth Okrant, MPH, MSP, PhD Kenneth Schellhase, MD, MPH Jeff Schiff, MD, MBA Lindsay Cogan, PhD

MAC Scorecard Committee Membership

Federal Government Members (non-voting)

Agency Agency Representative Agency for Healthcare Research and Quality (AHRQ) Kamila Mistry, PhD, MPH Substance Abuse and Mental Health Services Administration Laura Jacobus-Kantor, PhD Centers for Medicare & Medicaid Services (CMS) Marsha Smith, MD, MPH, FAAP Health Resources and Services Administration Suma Nair, MS, RD

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Measure Selection Criteria Overv rview

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Committee Overv rview and Key Points fr from Staff f Review of f Scorecard

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Charge of f th the MAC Scorecard Committee

The Scorecard Committee is charged with exploring the existing Child and Adult Core Set measures and recommending measures for removal from the Scorecard

• r recommending measures for addition to the Scorecard

that can be used to support the MAC Scorecard’s state health system performance pillar.

 Potential measures for addition to the Scorecard will focus on

addressing the use and usefulness of measure implementation and reporting.

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MAC Scorecard 1.0

Promote Effective Communication and Coordination of Care Domain NQF 0576 Follow-Up After Hospitalization for Mental Illness *NQF 1517 Prenatal and Postpartum Care: Postpartum Care Make Care Safer by Reducing Harm Caused in the Delivery of Care Domain Use of Multiple Concurrent Antipsychotics: Ages 1-17 Promote Effective Prevention & Treatment of Chronic Diseases Domain NQF 1392 Well-Child Visits: First 15 Months NQF 1516 Well-Child Visits: Ages 3-6 Adolescent Well-Care Visits: Ages 12-21 NQF 1407 Immunizations for Adolescents: Age 13 Percentage of Eligibles Who Received Preventive Dental Services: Ages 1-20 NQF 2940 Use of Opioids at High Dosage in Persons Without Cancer NQF 0004 Initiation & Engagement of Alcohol & Other Drug Dependence Treatment: Age 18 & Older NQF 0018 Controlling High Blood Pressure: Ages 18-85 Strengthen Engagement in Care Domain Getting Care Quickly (CAHPS) Getting Needed Care (CAHPS) Make Care Affordable Domain NQF 0272 PQI 01: Diabetes Short-Term Complications Admission Rate

14 *Endorsement removed

MAC C Sc Scorecard Propertie ies: Pil illa lar One Measure Ch Characteris istic ics

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▪ Insert table here

MAC Scorecard Characteristics # of Measures (n = 13)

Medicaid & CHIP Population Medicaid and CHIP Child Beneficiaries 6 Medicaid Adult Beneficiaries 7 NQF Endorsement Status Endorsed 8 Not Endorsed 5 Measure Type Structure Process 8 Outcome 2 Patient Experience of Care 1 Data Collection Method* Administrative Claims 10 Electronic Clinical Data 6 eMeasure Available Survey Data 1

*Data not mutually exclusive Note: Measure Type and Data Collection Method data unavailable for the following measures: Percentage of Eligibles Who Received Preventive Dental Services: Ages 1-20 and Adolescent Well-Care Visits: Ages 12-21

Number of

• f States Reporting th

the Medicaid id Ch Child ild Co Core Set t Measures, FFY2 Y2017

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10 20 30 40 50 60

Child and Adolescent Major Depressive Disorder: Suicide Risk… Audiological Evaluation No Later than 3 Months of Age BHRA: Behavioral Health Risk Assessment (for Pregnant Women) PC02: Cesarean Section Contraceptive Care: Postpartum Women Ages 15-20 Use of First-Line Psychosocial Care for Children and… DEV: Developmental Screening in the First Three Years of Life LBW: Live Births Weighing Less than 2,500 Grams DQA: Prevention: Dental Sealants for 6-9 Year Old Children at… FPC: Frequency of Ongoing Prenatal Care Use of Multiple Concurrent Antipsychotics in Children and… ADD: Follow-Up Care for Children Newly Prescribed Attention-… BMI: Body Mass Index Assessment: 3-17 Years PPC: Timeliness of Prenatal Care CAHPS: Consumer Assessment of healthcare Providers and… MMA: Medication Management for People with Asthma IMA: Immunization Status for Adolescents CIS: Childhood Immunization Status FUH: Follow-Up After Hospitalization for Mental Illness: Ages… CHL: Chlamydia Screening in Women Ages 16-20 AMB: Ambulatory Care: Emergency Department (ED) Visits CAP: Child and Adolescent's Access to Primary Care Practitioners W15: Well-Child Visits in the First 15 Months of Life AWC: Adolescent Well-Care Visits W34: Well-Child Visits in the Third, Fourth, Fifth, and Sixth… PDENT: Percentage of Eligibles who Received Preventive…

Denotes inclusion in Scorecard

Sources: Mathematica analysis of MACPro reports for the FFY 2017 reporting cycle Notes: The term “states” includes the 50 states and the District of Columbia.

Number of

• f States Reporting th

the Medicaid id Adult lt Co Core Set t Measures, FFY2 Y2017

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5 10 15 20 25 30 35 40 45 50

Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c… PC-03: Antenatal Steroids HIV Viral Load Suppression Screening for Clinical Depression and Follow-Up Plan PC-01: Elective Delivery Follow-up After ED Visit for Mental Illness or AOD Dependence Flu Vaccinations for Adults Ages 18-64 Medical Assistance With Smoking and Tobacco Use Cessation Contraceptive Care: Postpartum Women Ages 21-44 Use of Opioids at High Dosage in Persons Without Cancer Controlling High Blood Pressure PQI 05: COPD or Asthma in Older Adults Admission Rate PQI 08: Heart Failure Admission Rate Plan All-Cause Readmissions PQI 15: Asthma In Younger Adults Admission Rate CAHPS Health Plan Survery 5.0H, Adult Version (Medicaid) Comprehensive Diabetes Care: Hemoglobin A1c Poor Control (>9.0%) PQI 01: Diabetes Short-Term Complications Admission Rate Diabetes Screening for People with Schizophrenia or Bipolar Disorder… Initiation and Engagement of Alcohol and Other Drug Dependence… Adherence to Antipsychotics for Individuals with Schizophrenia Adult Body Mass Index Assessment Antidepressant Medication Management Annual Minitoring for Patients on Persistent Medications Comprehensive Diavetes Care: Hemoglobin A1c Testing Prenatal and Postpartum Care: Postpartum Care Breast Cancer Screening Cervical Cancer Screening Chlamydia Screening in Women Ages 21-24 Follow-Up After Hospitalization for Mental Illness: Aged 21 and Older

Measure Review Process

▪ Staff compiled Adult and Child Core Set measures into an

Excel spreadsheet, providing measure specification information

▪ Committee members submitted measure recommendations

from the universe of measures included in the Excel spreadsheet

▪ Staff completed a preliminary analysis algorithm on each

recommended measure

▪ Only measures recommended for review by Committee

members will be considered

▪ Measure specifications and preliminary analysis results will

be shared during the in-person meeting via an electronic discussion guide

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Committee Members’ Measure Recommendations for Addit ition and Removal

▪ Members submitted 50 measure recommendations

 Number of unique measure recommendations for addition: 19

» 2 measures are Scorecard 1.5 candidate measures and 11 measures have fewer than 25 reporting states, thus do not meet the criteria for consideration

 Number of unique measure recommendations for removal: 6

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Measure Recommendations for Addition

NQF # Title Core Set n/a Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA-AD) Adult 0038* Childhood Immunization Status (CIS-CH) Child 0105 Antidepressant Medication Management (AMM-AD) Adult 0139 Pediatric Central Line-Associated Bloodstream Infections (CLABSI-CH) Child 1448* Developmental Screening in the First Three Years of Life (DEV-CH) Child 1768* Plan All-Cause Readmissions (PCR-AD) Adult

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* Recommended by more than one member

Measure Recommendations for Removal

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Promote Effective Communication and Coordination of Care Domain ^NQF 1517 Prenatal and Postpartum Care: Postpartum Care Make Care Safer by Reducing Harm Caused in the Delivery of Care Domain Use of Multiple Concurrent Antipsychotics: Ages 1-17 Promote Effective Prevention & Treatment of Chronic Diseases Domain NQF 1392 Well-Child Visits: First 15 Months Adolescent Well-Care Visits: Ages 12-21 *NQF 2940 Use of Opioids at High Dosage in Persons Without Cancer NQF 0018 Controlling High Blood Pressure: Ages 18-85

* Recommended by more than one member ^ No longer NQF endorsed

Measure Recommendations for Addition – Not for Dis iscussion

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Sc Scorecard 1.5 1.5 Can andid idate Measures

NQF # Title Core Set 1932* Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD-AD) Adult 2372* Breast Cancer Screening (BCS-AD) Adult

* Recommended by more than one member Note: The measures presented in the table will not be reviewed.

Measure Recommendations for Addit ition – Not for Dis iscussion - Measures That Do Not Reach 25 State Min inim imum Reporting Threshold ld

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NQF 0139 Pediatric Central Line Associated Bloodstream Infections (CLABSI)

NQF # Title Core Set 2801 Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Child 2607 Diabetes Care for People with Serious Mental Illness: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (HPCMI-AD) Adult 0418/ 0418e* Screening for Depression and Follow-Up Plan Adult/Child 2605* Follow-Up After Emergency Department Visit for Mental Illness or Alcohol and Other Drug Abuse or Dependence (FUA/FUM-AD) Adult 0027* Medical assistance with Smoking and Tobacco Use Cessation Adult 0039* Flu Vaccinations for Adults Ages 18 to 64 Adult 1800* Asthma Medication Ratio: Ages 19 to 64 Adult

* Recommended by more than one member Note: The measures presented in the table will not be reviewed.

Measure Recommendations for Addit ition – Not for Dis iscussion - Measures That Do Not Reach 25 State Min inim imum Reporting Threshold ld

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NQF 0139 Pediatric Central Line Associated Bloodstream Infections (CLABSI)

NQF # Title Core Set 2902 Contraceptive Care – Postpartum Women Adult/Child 2903/ 2904* Contraceptive Care – All Women Adult/Child 1360 Audiological Evaluation no later than 3 months of age Child 0471 PC-02 Cesarean Birth Child

* Recommended by more than one member Note: The measures presented in the table will not be reviewed.

Questions?

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Key Considerations fr from CMCS

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Questions?

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Break

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Measure-Specific Recommendations on Strengthening th the Scorecard

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Measure Review Process

▪ Staff compiled Adult and Child Core Set measures into an

Excel spreadsheet, providing measure specification information

▪ Committee members submitted measure

recommendations from the universe of measures included in the Excel spreadsheet

▪ Staff completed a preliminary analysis algorithm on each

recommended measure

▪ Only measures recommended for review by Committee

members will be considered.

▪ Measure specifications and preliminary analysis results will

be shared during the in-person meeting via an electronic discussion guide

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Tools Used to Guide Measure Review

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MAP’s Measure Selection Criteria (MSC)

1

• NQF-endorsed measures are required for program measure sets, unless no relevant endorsed

measures are available to achieve a critical program objective 2

• Program measure set actively promotes key healthcare improvement priorities, such as those

highlighted in CMS’ “Meaningful Measures” Framework 3

• Program measure set is responsive to specific program goals and requirements

4

• Program measure set includes an appropriate mix of measure types

5

• Program measure set enables measurement of person- and family-centered care and services

6

• Program measure set includes considerations for healthcare disparities

and cultural competency 7

• Program measure set promotes parsimony and alignment

MAP Preliminary Analysis Algorithm

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1)

The measure addresses a critical quality objective not adequately addressed by the measures in the program set.

2) The measure is evidence-based and is either strongly linked to outcomes

• r an outcome measure.

3) The measure addresses a quality challenge. 4) The measure contributes to efficient use of measurement resources

and/or supports alignment of measurement across programs.

5) The measure can be feasibly reported. 6) The measure is applicable to and appropriately specified for the

program’s intended care setting(s), level(s) of analysis, and population(s).

7) If a measure is in current use, no negative unintended issues to the

patient have been identified.

8) If a measure is in current use, no implementation challenges outweighing

the benefit of the measure have been identified.

Review of f Voti ting Process

Voting on Measures

▪ Committee members who recommended measures for

discussion were assigned as lead discussants

 Lead discussants will introduce the measure, highlighting

specifications and its value to the Scorecard

 Lead discussants will liaise with measure developers to ensure

availability during the meeting

▪ Ensuing discussions will include all Committee members ▪ Public comments will be solicited after Committee

discussions

▪ After discussion of each measure and public comments, the

Committee will vote on the measure

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Measure by Measure Review: Measure Recommendations for Removal from the Scorecard

State Health System Performance Pil illar 1

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▪ Measure removals will be recommended from the

measures included in pillar one

▪ Measure removal recommendations represent measures

in three of the six domains

 Promote Effective Communication and Coordination of Care Domain -

Effective communication and coordination of care between beneficiaries, their families, and providers can prevent harm and promote improved health outcomes.

 Make Care Safer by Reducing Harm Caused in the Delivery of Care

Domain - Preventing harm caused in the delivery of care makes care safer for beneficiaries.

 Promote Effective Prevention & Treatment of Chronic Diseases

Domain - Promoting prevention and treatment of chronic diseases by encouraging activities such as regular screening and immunization helps beneficiaries lead healthier lives and reduces medical costs.

Potential Reasons for Removal fr from Scorecard

▪ Consistently high levels of performance (e.g., >95%),

indicating little room for additional improvement

▪ Multiple years of very low numbers of states reporting,

indicating low feasibility or low priority of the topic

▪ Change in clinical evidence has made the measure obsolete ▪ Measure does not provide actionable information for state

Medicaid program and/or its network of plans/providers

▪ Superior measure on the same topic has become available

Recommendations for Removal from the Scorecard

NQF # Measure Name Measure Steward

^1517 Prenatal and Postpartum Care: Postpartum Care National Committee for Quality Assurance N/A Use of Multiple Concurrent Antipsychotics: Ages 1-17 National Committee for Quality Assurance 1392 Well-Child Visits: First 15 Months National Committee for Quality Assurance N/A Adolescent Well-Care Visits: Ages 12-21 National Committee for Quality Assurance 2940 Use of Opioids at High Dosage in Persons Without Cancer Pharmacy Quality Alliance 0018 Controlling High Blood Pressure: Ages 18-85 National Committee for Quality Assurance

^No longer NQF-endorsed

NQF 1517 – Prenatal and Postpartum Care: Postpartum Care

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/1517 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#2 CACO

Number of states reporting on this measure: 38

N/A – Use of f Multiple Concurrent Antipsychotics: Ages 1-17 17

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

Number of states reporting on this measure: 35

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html# 6HARM

NQF 1392 – Well-Child Vis isits: First 15 Months

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/1392 Number of states reporting on this measure: 49

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html# 9PREV

N/A –Adolescent Well ll-Care Vis isits: Ages 12-21 21

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

Number of states reporting on this measure: 49

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html# 10PREV

NQF 2940 Use of f Opioids at t Hig igh Dosage in in Persons Wit ithout Cancer

Mea easure Steward: Pharmacy Qualit lity Allia lliance

QPS Link: http://www.qualityforum.org/QPS/2940 Number of states reporting on this measure: 23

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html# 11PREV

NQF 0018 Controlli ling Hig igh Blo lood Pressure: Ages 18-85 85

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/0018 Number of states reporting on this measure: 25

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html# 12PREV

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Opportunity for Public Comment & Break

Review of f th the Voting Process

45

Decision Categories

46

▪ Committee must reach a decision about every measure

discussed

 Each decision should be accompanied by one or more

statements of rationale that explains why each decision was reached

▪ Decision categories include:

» Support » Support with conditions » Do not support

▪ Tallying the votes:

 Quorum - 66% of Committee required to be present for voting  ≥60% of votes denote the result of voting

Voting Decision Categories

47

SUPPORT

• Ready for immediate use
• Relevant to all stages of life
• Outcome measures

CONDITIONAL SUPPORT

• Pending endorsement from NQF
• Pending CMS confirmation of

feasibility DO NOT SUPPORT

• Measure and/or measure focus inappropriate or

a poor fit for the Scorecard

• Duplication of efforts
• Resource constraints
• State Medicaid agencies will need to tweak

and/or vary the level of analysis to increase measure adoption and implementation

Committee Votes to Recommend Each Measure for Removal

▪ Vote to support or conditionally support removal of:

 ^NQF 1517 Prenatal and Postpartum Care: Postpartum

Care

 N/A Use of Multiple Concurrent Antipsychotics in Children

and Adolescents

 NQF 1392 Well-Child Visits: First 15 Months  Adolescent Well-Care Visits: Ages 12-21  *NQF 2940 Use of Opioids at High Dosage in Persons

Without Cancer

 NQF 0018 Controlling High Blood Pressure: Ages 18-85

* Recommended by more than one member ^ No longer NQF endorsed

Lu Lunch

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50

Measure by Measure Review: Potential Gap-Filling Measures for Addition to the Scorecard

Measure Review for Potential Addition to th the Scorecard

51

▪ Recommendations are guided by the Measure

Selection Criteria, feedback from state implementers and Medicaid population specific gap areas not addressed in Scorecard 1.0

▪ A Medicaid specific algorithm and preliminary

analysis was used as a standardized way to organize discussion on potential measure recommendations

▪ Committee members submitted measure

recommendations for strengthening the Scorecard

Measures for Potential Addition to th the Scorecard

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▪ All measures recommended to CMS will at a

minimum:

 Satisfy the State Health System Performance pillar and

domains

 Be publicly reported (reported by 25 or more states)  Fill a gap area in Scorecard 1.0

State Health System Performance Pil illar 1

53

▪ Measure additions will be recommended for inclusion in

pillar one

▪ Measure recommendations represent measures in three

• f the six domains

 Make Care Safer by Reducing Harm Caused in the Delivery of Care

Domain - Preventing harm caused in the delivery of care makes care safer for beneficiaries.

 Promote Effective Prevention & Treatment of Chronic Diseases

Domain - Promoting prevention and treatment of chronic diseases by encouraging activities such as regular screening and immunization helps beneficiaries lead healthier lives and reduces medical costs.

 Make Care Affordable Domain - Making care affordable by optimizing

resource use helps Medicaid and CHIP beneficiaries access the care they need and may lead to better health outcomes.

Recommendations for Addit ition to the Scorecard

NQF #

Measure Name Measure Steward Domain

N/A Adherence to Antipsychotic Medications for Individuals with Schizophrenia (SAA-AD) Centers for Medicare and Medicaid Services Make Care Safer by Reducing Harm Caused in the Delivery of Care 0105 Antidepressant Medication Management (AMM-AD) National Committee for Quality Assurance Make Care Safer by Reducing Harm Caused in the Delivery of Care 0139 Pediatric Central Line Associated Bloodstream Infections (CLABSI) Centers for Disease Control and Prevention Make Care Safer by Reducing Harm Caused in the Delivery of Care

Recommendations for Addit ition to the Scorecard

NQF #

Measure Name

Measure Steward Domain 0038 Childhood Immunization Status National Committee for Quality Assurance Promote Effective Prevention & Treatment of Chronic Diseases 1448 Developmental Screening in the First Three Years of Life Oregon Health & Science University Promote Effective Prevention & Treatment of Chronic Diseases 1768 Plan All-Cause Readmissions National Committee for Quality Assurance Make Care Affordable

N/A Adherence to Antip ipsychotic Medic ications for In Indiv ivid iduals wit ith Schiz izophrenia (SAA-AD)

Mea easure Steward: : Ce Centers for Med edicare e and Med edicaid Ser ervices

Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#3 PREV

Number of states reporting on this measure: 32

NQF 0105 Antid idepressant Medication Management (AMM-AD)

Mea easure Steward: Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/0105 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#4 HARM

Number of states reporting on this measure: 34

NQF 0139 Pedia iatric ic Central Lin ine Associated Blo loodstream In Infections (CLABSI)

Mea easure Steward: : Ce Centers for Dis Disease Con Control and Prevention

QPS Link: http://www.qualityforum.org/QPS/0139 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#5 HARM

NQF 0038 Child ildhood Im Immunization Status

Mea easure Steward: Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/0038 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#7 PREV

Number of states reporting on this measure: 44

NQF 1448 Develo lopmental Screenin ing in in the Fir irst Three Years of Lif ife

Mea easure Steward: Oreg egon He Health & Scien cience Univ iversity

QPS Link: http://www.qualityforum.org/QPS/1448 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#8 PREV

Number of states reporting on this measure: 27

NQF 1768 Pla lan All ll-Cause Readmis issions

Mea easure Steward: : Nati tional Com Committee ee for

• r Qualit

lity Assurance

QPS Link: http://www.qualityforum.org/QPS/1768 Discussion Guide Link:

http://publicstaff.qualityforum.org/MAP/Medicaid%20and%20CHIP %20(MAC)%20Scorecard/MAC_Scorecard_Discussion_Guide.html#1 PREV

Number of states reporting on this measure: 25

62

Opportunity for Public Comment & Break

Review of f th the Voting Process

63

Review of f Voti ting Process

Voting on Measures

▪ Committee members who recommended measures for

discussion were assigned as lead discussants

 Lead discussants will introduce the measure, highlighting

specifications and its value to the Scorecard

 Lead discussants will liaise with measure developers to ensure

availability during the meeting

▪ Ensuing discussions will include all Committee members ▪ Public comments will be solicited after Committee

discussions

▪ After discussion of each measure and public comments, the

Committee will vote on the measure

64

Decision Categories

65

▪ Committee must reach a decision about every measure

discussed

 Each decision should be accompanied by one or more

statements of rationale that explains why each decision was reached

▪ Decision categories include:

» Support » Support with conditions » Do not support

▪ Tallying the votes:

 Quorum - 66% of Committee required to be present for voting  ≥60% of votes denote the result of voting

Voting Decision Categories

66

SUPPORT

• Ready for immediate use
• Relevant to all stages of life
• Outcome measures

CONDITIONAL SUPPORT

• Pending endorsement from NQF
• Pending CMS confirmation of

feasibility DO NOT SUPPORT

• Measure and/or measure focus inappropriate or

a poor fit for the Scorecard

• Duplication of efforts
• Resource constraints
• State Medicaid agencies will need to tweak

and/or vary the level of analysis to increase measure adoption and implementation

Committee Votes to Recommend Each Measure for In Inclusion

* Denotes measures recommended by TF members

▪ Vote to support (or conditionally support) inclusion of:

 N/A Adherence to Antipsychotic Medications for Individuals

with Schizophrenia (SAA-AD)

 0105 Antidepressant Medication Management (AMM-AD)  0139 Pediatric Central Line Associated Bloodstream

Infections (CLABSI)

 0038 Childhood Immunization Status  1448 Developmental Screening in the First Three Years of

Life

 1768 Plan All-Cause Readmissions

Adjourn for the Day

Medicaid and CHIP (M (MAC) ) Scorecard Committee In In-Person Meeting

Day 2: January 11, 2019

Welcome

70

Welcome

71

▪ Restrooms

 Exit main conference area, past elevators, on right.

▪ Breaks

 10:40 am – 15 minutes  12:40 pm – 15 minutes

▪ Laptops and cell phones

 Wi-Fi network

» User name: guest » Password: NQFguest

 Please mute your cell phone during the meeting

▪ Public comment period

 Dedicated times for public comment  Comment via chat box at any time and comments will be shared

during dedicated times

72

Ranking of Measure Recommendations

Ranking Measures with Support for Addition

▪ Committee members will prioritize measures selected

for addition (day one). Priority will indicate the order in which the Committee recommends CMS add the measures to the set.

74

Opportunity for Public Comment & Break

MAC Scorecard Measures to Drive Change in Health System Performance

75

Dis iscussion Questions

▪ From the state Medicaid perspective, what health

system performance changes do you expect from the Scorecard?

▪ What aspects of health system performance can be

impacted with the Scorecard?

▪ How can existing Scorecard measures be tweaked to

increase impact?

▪ What state level factors are important for maximizing

Scorecard impact on health system performance?

76

Future Directions for the MAC Scorecard

77

Dis iscussion Questions

▪ From the state Medicaid perspective, what do you see

the Scorecard evolving in the future?

▪ How can the evolution be maximized? ▪ What processes are necessary to foster and facilitate

maximize Scorecard evolution?

▪ How can state’s proactively participate in this evolution

and maximize Scorecard impact on health system performance?

78

79

Opportunity for Public Comment

Next Steps

80

Im Important Dates

81

▪ January 16: Post-meeting web meeting ▪ February 25 to March 27: Draft report posted for public

comment

▪ April 25: Post Comment web meeting ▪ May 29: Strategic Considerations web meeting #1 ▪ June 26: Strategic Considerations web meeting #2 ▪ July 29: Strategic Considerations web meeting #3 ▪ September 9: Final report due to CMCS and made

available to the public

Project Contact In Info

▪ Email: macscorecard@qualityforum.org ▪ NQF phone: 202-783-1300 ▪ Project page:

http://www.qualityforum.org/MAC_Scorecard.aspx

▪ SharePoint site:

http://share.qualityforum.org/Projects/MAC%20Scoreca rd/SitePages/Home.aspx

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