June 29th, 2018 1 Agenda Meeting goals and agenda overview Public - - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP

June 29th, 2018

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• Meeting goals and agenda overview
• Public comment (1:15 PM)
• Refresher on Phases 1-3 and measures
• Where we’ve been and where are we going
• Workgroup areas of interest
• Areas prioritized by workgroup
• Conclude review of “ready” metrics for Phase 1 (2018)
• “Near ready” metrics for Phase 2 (2019+)
• Metrics with potential that have been identified
• Temperature check
• Process for exploring these metrics
• Summary and Next Steps

Agenda

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Public Comment

• Recommend one or more measures
• f HAKR to be applied as CCO

incentive measures. Could include:

• “Ready” measures for 2018
• Glide path measures for 2018
• “Near ready” measures for 2019+
• Document interest in “new”

measures

• Consider other recs to achieve

desired goals

Shared accountability and cross- sector action to achieve kindergarten readiness

• Pilot/test any recommended

“near ready” measures

• If testing/development is

complete, formally recommend any now “ready” measures for adoption

• Explore development of “new”

measures (if applicable and resources available)

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“Ready” measure = Validated measure with specifications, applied use, and benchmarks; meets four core requirements for CCO Incentive Metric Program; measure ready for Phase 1 (2018) “Near ready” measure = Specifications developed, has been applied in some setting, but not at a CCO/MCO/health system level; data connections need work; measure ready for Phase 2 (2019+) “New” measure = Measure concept, no specifications, no applied use

• Explore potential to apply

measures to other health plans and payers

• Explore opportunities for shared

measurement (e.g. integrating the health system quality measures into the early learning system data dashboard)

• Explore opportunities for joint

accountability

Phase1 (2018) Phase 2 (2019+) Phase 3 (2020+)

Within Scope

• Adopt a conceptual framework for the health sector’s role in kindergarten readiness
• Identify metrics that can operationalize components of the health sector’s role in

kindergarten readiness to recommend to M&SC and HPQMC in Fall 2018

• “Ready” and “near ready” person-level metrics
• Possible glide path CCO-level metrics

Outside of Scope

• Joint accountability with the Early Learning System
• Health sector developing a new definition of kindergarten readiness
• Health sector developing a new kindergarten assessment that measures child
• utcomes and abilities to administer within health care settings

Workgroup Role: 2018

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Measure Criteria for “Ready” Metrics to be Proposed for Phase 1 (2018)

Created for HAKR Technical Work Group

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Where We’ve Bee Been an n and d Wher here e We e Ar Are e Going Going

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1) HAKR Conceptual Framework 2) HAKR Measurement Criteria

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1) A Only 2) A + B, Proposal for C 3) A, Proposal for C 4) B + C 5)A, Proposal C

Potential Options:

* HAKR staff team is leaning towards this option

Options for Proposals to Metrics & Scoring Committee in Fall 2018

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Current CCO Metrics & “Ready” Metrics Assessed for Phase 1 (2018) (Mean Score on HAKR Criteria Across HAKR Workgroup Members)

1) A Only 2) A + B, Proposal for C 3) A, Proposal for C 4) B + C 5)A, Proposal C

Potential Options:

* HAKR staff team is leaning towards this option

Options for Proposals to Metrics & Scoring Committee in Fall 2018

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Phase 1 (2018)

Glide Path Metric Tied to CCO-Level Activities (e.g. related to behavioral health services for young children)

(Option B) Phase Phase 2 (2019+) “Near Ready” Metric Tied to Child/Parent-Level Domain of Mental Health (e.g. child mental health utilization) (Option C)

Example of an A + B + Proposal for C Option (this is just an example)

Phase 1 (2018) “Ready” Metrics

1)WCV 3-6 2)Dental Sealants (Option A)

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June

• Clarify options for

moving forward

• Conclude review
• f “ready” metrics

for Phase 1 (2018)

• Review and gather

input on potential “near ready” metrics for Phase 2 (2019+)

July

• Review “near

ready” metrics for Phase 2 (2019+)

• Assess “near

ready” metrics using workgroup measure criteria

August

• Review glide path

metrics for Phase 1 (2018)

• Summarize all
• ptions for

measure recommendations (“ready”, “near ready”, glide path)

• Document

interest in “new” metrics

September

• Prioritize options

for measure recommendations

• Build consensus
• n final

workgroup recommendations

October

• Review

workgroup report with final recommendations

Timeline and Work Plan

Review of view of Metrics Metrics tha that t Ad Addr dress ess Wor

• rkg

kgroup

• up

Inter Interest est Ar Areas eas

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Areas of HAKR Workgroup Interest & Parent Focus Group Priorities: Metrics at a Child-level

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Areas of HAKR Workgroup Interest & Parent Focus Group Priorities: Metrics at a Mother or Parent/Caregiver Level

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Reviewed Whether There are Available Metrics to Address HAKR Priority Areas

• Literature and metric website search for applicable metrics

– National Quality Forum – National Quality Metrics Clearing House – http://www.buyingvalue.org/resources/toolkit/ – Professional consultation

• No additional “Ready” metrics for Phase 1 (2018) in your priority areas
• Identified a set of “Near Ready” metrics that could be considered for Phase 2 (2019+) because they have

established specifications and have been implemented

• Examples of reasons they did not meet criteria for “Ready” metrics for Phase 1 (2018)

– Not designed with a health system analysis – Data source = medical chart review – Denominator is all children or adults, hasn’t been applied for children 0-6 – Requires new data connections across systems – Requires policies or policy clarifications, payments and capacity

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HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified

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HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified

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HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified

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Experience of Care Metrics Based on CAHPS HP - 5

CAHPS HP 5 Items on Experience - Under the section on the child’s personal doctor or nurse, there are these items:

• 12. In the last 6 months, how often did your child’s personal doctor explain things about your child’s health in a

way that was easy to understand?

• 13. In the last 6 months, how often did your child’s personal doctor listen carefully to you?
• 14. In the last 6 months, how often did your child’s personal doctor show respect for what you had to say?
• 15. Is your child able to talk with doctors about his or her health care? 1 Yes 2 No → If No, go to #17

– 16. In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy for your child to understand? – 17. In the last 6 months, how often did your child’s personal doctor spend enough time with your child? Limitation to Current Sampling, Timing of Data Collection, and Past CCO Experiences in “Attainability” of Improving

• n the CAHPS Metrics

❖ Sample is ONLY for parents of children 0-6 who indicated they had a personal doctor or nurse and could answer these questions and be included in the denominator for the metric, likely to not have enough sample for an incentive metric ❖ Data reported and available nearly a year after it is collected ❖ Data not actionable in targeting who or where there are needs for improvement as it is not collected at a clinic-level but is for a subset for population

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HAKR Priority Areas – “Near Ready” Metrics Identified

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection (5 CCO metrics, 4 Available Phase 1 Metric)

• 1. Vision Screening
• 2. Psychosocial Screening Using the Pediatric Symptom Checklist-Tool
• 3. Maternal depression screening in child’s visits

HAKR Conceptual Domain: Follow-Up to Address Risks Identified (No current CCO metrics or available Phase 1 Metric)

• 4. Mental health utilization
• 5. Use of first line psychosocial care for children and adolescents on antipsychotics.
• 6. Follow-up to Developmental Screening*+

HAKR Conceptual Domain: Care for CYSHCN+ (No current CCO metrics or available Phase 1 Metric)

• 7. Family Experience of Care Coordination+
• 8. Pediatric Integrated Care Survey+

Population: Births/Mothers: HAKR Conceptual Domain: Prevention, Promotion, Early Detection (2 CCO Metrics)

• 9. Unexpected newborn complications
• 10. Low-birth weight
• 11. Behavioral health risk assessment for pregnant women
• 12. Prenatal and Postpartum Depression Screening

* Metric identified by Metrics and Scoring

+ Metric identified by HPQM

Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection (5 CCO metrics, 4 Available “Ready” Metrics)

• 1. Vision Screening:

– Developed by Institute for Clinical Systems Improvement, used in a quality improvement context – Based on clinical data (Data available in the medical chart and through chart review) – Metric #1: Percentage of children five year and younger who have had a vision impairment screening’ – Metric #2: Screening for Reduced Visual Acuity and Referral in Children (as documented in the chart)

• 2. Psychosocial Screening Using the Pediatric Symptom Checklist-Tool

– Developed by Massachusetts General Hospital – Based on claims and clinical data – Metric: Percentage of children from 3.00 to 17.99 years of age seen for a pediatric well child visit who have a Pediatric Symptom Checklist (PSC) Tool administered as a component of that visit.

• 3. Maternal depression screening in child’s visits

– Developed by National Committee for Quality Assurance – Physician Level Metric and North Carolina Medicaid – Based on chart and/or claims data – Metric: Percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life

HAKR Priority Areas – “Near Ready” Metrics Identified

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Population: Children HAKR Conceptual Domain: Follow-Up to Address Risks Identified (No current CCO metrics, No “Ready” Metrics)

• 4. Mental health utilization

– Developed by National Committee for Quality Assurance – Based on claims data, for all ages – Metric: Mental health utilization: number and percentage of members receiving the mental health services during the measurement year: any service, inpatient, intensive outpatient or partial hospitalization, and

• utpatient or ED.
• 5. Use of first line psychosocial care for children and adolescents on antipsychotics

– Developed by National Committee for Quality Assurance – Based on claims data. – Metric: Assesses whether children and adolescents without an indication for antipsychotic medication use had documentation of psychosocial care as first-line treatment before being prescribed an antipsychotic medication.

HAKR Priority Areas – “Near Ready” Metrics Identified

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Population: Children HAKR Conceptual Domain: Follow-Up to Address Risks Identified (No current CCO metrics, No “Ready” Metrics)

• 6. Follow-up to Developmental Screening*+

– Developed by Oregon Pediatric Improvement Partnership – Based on claims data and clinical data – Metric: Assesses proportion of children identified at-risk for delays who received follow-up.

• Version 1: Follow-Up: Referrals to Early Intervention, Developmental and Behavioral Pediatrician, or Medical

Therapy Services (Occupational Therapy, Speech Therapy)

• Version 2: Follow-Up Tailored to Risk Levels Identified: Expands Follow-Up, Based on Risk Level to Include

Other Services – Developmental promotion and rescreen in 3 months (lower risk levels) – Parenting classes and parenting supports – Internal behavioral health – External infant and specialty mental health (Child psychotherapy and Parent Child Interaction Therapy) – Applicable and available home visiting services

HAKR Priority Areas – “Near Ready” Metrics Identified

* Metric identified by Metrics and Scoring

+ Metric identified by HPQM

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Population: Children HAKR Conceptual Domain: Care for CYSHCN+ (No CCO metrics, No “Ready” metrics)

• 7. Family Experience of Care Coordination+

– Developed by Center of Excellence on Quality of Care Measures for Children With Complex Needs (COE4CCN) – Based on survey completed by the parent – Various Metrics Included and Derived from Parent Responses to the Survey: 20 separate and independent quality indicators related to care coordination for children with medical complexity. Each indicator’s numerator is determined by caregiver response to specific questions, as described in the detailed measure specifications section of the candidate measure submission form (CPCF).

• 8. Pediatric Integrated Care Survey+

– Developed by Boston Children's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health – Based on a survey completed by parent – Various Metrics Included and Derived from Parent Responses to the Survey: 5 metrics focused the following: access, communication, family impact, care goal creation, and team functioning.

HAKR Priority Areas – “Near Ready” Metrics Identified

* Metric identified by Metrics and Scoring

+ Metric identified by HPQM

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Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection (2 CCO Metrics)

• 9. Unexpected newborn complications

– Developed by California Maternal Quality Care Collaborative – Based on Claims, patient discharge notes, birth certificate, medical chart data – Metric: Rate of newborns diagnosed with severe or moderate complications among those term, normally grown, and without pre-existing conditions

• 10. Low-birth weight

– Developed by Agency for Healthcare Research and Quality (AHRQ) – Based on claims data, Prevention Quality Indicators software – Metric: Low birth weight (<2500 grams) infants per 1,000 newborns

• 11. Behavioral health risk assessment for pregnant women

– Formerly a CMS Child Core Set, although dropped and now no measure steward – Based clinical data – Metric: Percent of patients who gave birth who received a behavioral health risk assessment that includes the following screenings at the first prenatal visit: depression, alcohol use, tobacco use, drug use, intimate partner violence

HAKR Priority Areas – “Near Ready” Metrics Identified

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Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection (2 CCO Metrics)

• 12. Prenatal and Postpartum Depression Screening

– Developed by Illinois Medicaid – Based on birth record data, claims (including HCPCS codes) – Metric: Percentage of deliveries (live and non-live births) were the woman was administered one or more depression screenings (Prenatal: 9 months before, Postnatal: 12 months after)

HAKR Priority Areas – “Near Ready” Metrics Identified

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Temper emperatur ture e Chec Check on k on “Near Ready” Metrics Metrics Identified Identified

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Next Steps: Process to Explore “Near Ready” Metrics to Determine How and Which Ones Should be Assessed in July

Staff Team will:

• Review HAKR workgroup feedback obtained today
• Review Clinical Soundness of the metric - alignment to clinical recommendations
• Review Technical Properties of the metric - implications for resources needed to develop a

CCO-level metric

• Review Feasibility of collecting the metric - implications for the resources needed to refine

the metric, resources needed to pilot metric at the CCO-level, resources needed to develop measurement systems

• Review degree to which the Policies and Payments are aligned with the metric as this

impacts measure feasibility, usability, and what would be shared to inform assessments

• Review alignment with HAKR Goals and HAKR Measure Criteria

Opportunity to Weigh In on 2019 CCO Metrics Challenge Pool

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THANK YOU!

Meeting Schedule July 27, 2018: 10 AM – 1 PM August 27, 2018: 1 – 4 PM September 11, 2018: 1 – 4 PM

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