Metrics & Scoring Committee February 26, 2016 *Approve January - - PDF document

Metrics & Scoring Committee

February 26, 2016

Consent agenda

*Approve January minutes

Agenda Overview

• Updates
• Public testimony
• Continue discussion on framework and mechanics for

CCO incentive program under new waiver

• Presentation on Public Health Modernization / State

Health Improvement Plan priority areas

• Year Three Clinical

Quality Metrics

• Hospital Transformation

Performance Program

• Medicaid waiver renewal

Public Testimony

CONTINUED DISCUSSION ON FRAMEWORK AND MECHANICS FOR CCO INCENTIVE PROGRAM UNDER NEW WAIVER

January Recap

The Committee began thinking about the structure of the incentive measure program under the new waiver, specifically establishing a core and menu set approach to the incentive measures. Extensive discussion on measurement fatigue, measure alignment, measuring transformation and integration, supporting local priorities, and more. Committee members were given homework to ponder in advance of discussion today.

What does a transformed system look like to you? What will tell you that health system transformation in Oregon has been successful?

Which few (2-3) measures would you incentivize to get there?

What are the outcome and process measures for these incentive measures?

Incentive Measure Program Structure

As requested by Committee, staff consulted with Michael Bailit to identify potential variations for quality pool distribution if the CCO incentive measure program moves to a core / menu set approach for the new Medicaid demonstration waiver (2018 – 2022). See handout for full description of these options. Note all options assume that the Committee will select a fixed number

• f measures in the core and menu sets, and that there will be a total

number of measures that all CCOs are held accountable for (even if which measures vary by CCO due to menu selection).

Current Quality Pool Structure (2015)

Number of Measures Met % of quality pool payment for which CCO is eligible At least 12 (inc. EHR adoption, PCPCH enrollment) 100% At least 12 (not inc. EHR or PCPCH) 90% At least 11.6 80% At least 10.6 70% At least 8.6 60% At least 6.6 50% At least 4.6 40% At least 3.6 30% At least 2.6 30% At least 1.6 10% At least 0.6 5% Fewer than 0.6 No quality pool payment

Levers for Quality Pool Distribution

Variations for the quality pool distribution can be summarized as three levers that can be used independently, or in combination. 1) Raise or lower the “gate” (the minimum score needed for any payment) 2) Raise or lower the rungs of the “ladder” (levels of performance needed to earn payment, how high is the top of the ladder) 3) Allow for variable point allocation for all measures, or just menu measures.

Variations: Tiered Approaches

• Continue to utilize a tiered approach + challenge pool.
• Option 1a: recommend total number of measures required to earn

100% of the quality pool.

• Option 1b: raise or lower the bar, require higher (or lower) level of

performance to earn 100% of the quality pool.

% of quality pool payment for which CCO is eligible Number of measures met (easy) Number of measures met (medium) Number of measures met (hard) 100% 9 11 12 90% 8 10 11 80% 7 8 10 60% 6 6 8

Variations: Tiered Approaches (1b)

12 measures at $10 each = $120 quality pool available per CCO

CCO A meets 11 measures, earns $110 of $120 available; $10 remaining goes toward challenge pool.

CCO B meets 9 measures, earns $90 of $120 available; $30 remaining goes toward challenge pool.

Variations: Variable Weights

• Each measure (core and menu) is assigned a point value.

Committee recommends total point value that must be met to earn quality pool (can still have tiered distribution).

• Option 2a: all measures are worth the same point value.
• Option 2b: core measures are worth 1 point; menu measures lower

point value.

Variations: Variable Weights (cont.)

• Option 2c: Recommend higher or lower weights to certain measures

to provide emphasis in certain areas (e.g., more transformational measures are worth more points).

• Option 2d: Assign full point value for meeting the benchmark (1 pt)

and fewer points for meeting improvement targets (½ pt). Likely demotivating to CCOs – not recommended at this time.

Next Steps?

PUBLIC HEALTH DIVISION Office of the State Public Health Director

Public Health Modernization and the State Health Improvement Plan

Lillian Shirley, BSN, MPH, MPA Public Health Director Oregon Health Authority Metrics and Scoring Committee February 26, 2016

Modernization of Oregon’s Public Health System

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What does governmental public health do?

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Task Force on the Future of Public Health Services

• Met in 2014 to develop

recommendations for a public health system for the future.

• The Modernizing

Oregon’s Public Health System report was submitted to the legislature in Sept 2014.

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House Bill 3100 (2015)

Put into place the recommendations from the Modernizing Oregon’s Public Health System report:

• Adopts the foundational capabilities and programs for

governmental public health.

• Changes the composition and role of the Public Health

Advisory Board beginning on January 1, 2016.

• Requires the Oregon Health Authority’s Public Health Division

and local public health authorities to assess their current ability to implement the foundational capabilities and programs; and requires the Public Health Division to submit a report on these findings to the legislature by June 2016.

• Requires local public health authorities to submit plans for

implementing the foundational capabilities and programs by December 2023.

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Why modernize Oregon’s public health system?

• Public health has traditionally provided a safety net for individuals

without health insurance, and due to the Affordable Care Act, Oregon’s uninsured rate has plummeted.

• Without needing to provide health care for a substantial number of

uninsured individuals, public health can focus on developing policies and programs that can sustain lifelong health for everyone.

• A focus on policies and programs that can help everyone be healthy

will yield cost and time savings for the health care delivery system.

• Investments in public health vary from county to county, leading to

disparities in services.

• Oregon’s public health system relies heavily on federal categorical

grants, which do not always meet the unique needs of our state.

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What does public health modernization mean for my community?

• Modernization of public health means that everyone in Oregon will

be served by a health department that provides for: – Timely and comprehensive data on the health of their population in order to inform community health assessments and community health improvement plans; – Response to emerging health threats like natural disasters and communicable diseases; – Clear and comprehensive communications about important health issues; – Assurance that community members have access to healthy foods and safe places to play and be active.

Progress to date

• Developed a Public Health Modernization Manual, with detailed

definitions for each foundational capability and program.

• New Public Health Advisory Board members have been appointed

by the Governor’s office.

• Each state and local public health authority is currently assessing its

ability to meet the foundational capabilities and programs.

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Next steps

Activity Timeline Public Health Advisory Board will meet monthly Throughout 2016 Public Health Division and local public health authorities will assess ability to implement foundational capabilities and programs Jan-March 2016 Submit report with assessment findings to the Oregon legislature June 2016 Identify health outcomes and cost savings attributable to public health interventions September 2016 With communities and partners, state and local health departments will develop plans to implement the foundational capabilities and programs. Beginning July 2016

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Performance measures

• Per HB 3100, the Public Health Advisory Board will develop a plan

for the use of incentives to encourage the effective and equitable provision of public health services.

• This work is anticipated to begin in Spring 2016.

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State Health Improvement Plan

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Oregon’s State Health Improvement Plan will improve the health of all people in Oregon by 2020 by:

Setting common goals Reducing avoidable differences in health outcomes among diverse communities Addressing the leading causes

• f death,

disease, and injury

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The Public Health Division has oversight of the SHIP. However, strategies won’t be met without broad engagement of health systems, community

• rganizations, local public

health, state agencies and

• thers.

State Health Improvement Plan priorities

• Prevent and Reduce Tobacco Use
• Slow the Increase of Obesity
• Improve Oral Health
• Reduce Harms Associated with Substance Use
• Prevent Deaths from Suicide
• Improve Immunization Rates
• Protect the Population from Communicable Diseases

Approach to meet goals

• Priorities need to be understandable, measureable, and achievable

within five years

• Each priority area contains interventions on multiple levels:

– Population health – Health system – Health equity

Prevent and reduce tobacco use

Priority targets:

• Cigarette smoking prevalence among youth
• Other tobacco product (non-cigarette) use among youth
• Cigarette smoking prevalence among adults

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Cigarette smoking prevalence

37 0% 5% 10% 15% 20% 25% 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Percent Adult 8th graders

New BRFSS weighting method began in 2010. Oregon Behavioral Risk Factor Surveillance System (BRFSS) Student Drug Use Survey (1996, 1998, 2000), YRBS (1997, 1999), Oregon Health Teens Survey (2000-2009, 2011, 2013), Student Wellness Survey (2010, 2012) Sources:

Slow the increase of obesity

Priority targets:

• Obesity prevalence among 2- to 5-year olds
• Obesity prevalence among youth
• Obesity prevalence among adults
• Diabetes prevalence among adults

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Obesity prevalence

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10.7% 26.8%

0% 10% 20% 30% Percent Adults 8th Graders

New BRFSS weighting method began in 2010.

7.3%

Oregon Behavioral Risk Factor Surveillance System (BRFSS) Oregon Healthy Teens Survey Source:

10%

Improve oral health

Priority targets:

• Third graders with cavities in their permanent teeth
• Adolescents with one or more new cavities identified during a dental

visit in the previous year

• Prevalence of older adults who have lost all their natural teeth

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Oral health status of children 6-9 years

• ld, Oregon, 2002, 2007 & 2012

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57% 24% 16% 64% 36% 20% 52% 20% 14%

0% 10% 20% 30% 40% 50% 60% 70% Had a Cavity Untreated Decay Rampant Decay Percent of children 6–9 years

Oregon Smile Survey, 2002, 2007 and 2012 Source:

2002 2007 2012

Cavities rates^ by geographic region, Oregon, Smile Survey, 2012

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^ 6- to 9-year-olds, primary and permanent teeth * Statistically different from the statewide average of 52%

Reduce harms associated with alcohol and substance use

Priority targets:

• Prescription opioid mortality
• Alcohol-related motor vehicle deaths

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Opioid-related overdose deaths by year, Oregon

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1.7 5.8

1 2 3 4 5 6 7 8 Rate per 100,000 residents

Oregon Death Certificate Data Source:

Alcohol-related deaths by age group and sex, Oregon, 2013

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6 13 41 78 18 33 99 130

20 40 60 80 100 120 140 15–24 25–44 45–64 65+ Rate per 100,000 residents Age group in years

Oregon Death Certificate Data Source:

Female Male

Prevent deaths by suicide

Priority targets:

• Rate of suicide
• Suicide attempts among eighth graders
• Emergency department visits for suicide attempts

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Suicide deaths by year, Oregon and U.S.

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13.9 Oregon 16.8 10.5 U.S 12.6

4 8 12 16 20 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Rate per 100,000 residents (age-adjusted)

CDC's WISQARS Source:

Suicide deaths by sex and age, Oregon, 2007-2013 average

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2.8 4.6 8.9 12.8 6.6 5.4 23.6 30.4 37.8 41.4

5 10 15 20 25 30 35 40 45 10 to 17 18 to 24 25 to 44 45 to 64 65+ Rate per 100,000 residents Age in years

Oregon Death Certificate Data Source:

Female Male

Improve immunization rates

Priority targets:

• Rate of 2-year-olds who are fully vaccinated
• HPV vaccination series rate among 13- to 17-year-olds
• Seasonal flu vaccination rate in people ≥ months of age

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(Enter) DEPARTMENT (ALL CAPS) (Enter) Division or Office (Mixed Case)

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Range: 48% to 81%

Influenza vaccination rate by age, Oregon 2014-2015 season

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60% 39% 36% 23% 17% 21% 28% 28% 29% 30% 36% 45% 61% 75% 80% 74% 53%

0% 20% 40% 60% 80% Percent of population Age group

Oregon ALERT Immunization Information System Source:

Protect the population from communicable diseases

Priority targets:

• Gonorrhea in women aged 15-44 years
• HIV infections in Oregon residents
• Hospital-onset Clostridium difficile infections
• Infections caused by Shiga toxin-producing Escherichia coli

infections in children less than 10 years old

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Newly diagnosed HIV infection by likely mode of transmission, Oregon, 2014

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Men who have sex with men (MSM) only 57% Injection drug users (IDU) only 8% MSM / IDU 13% Heterosexual / Other* 22%

Oregon Reportable Diseases Database Source: *Includes cases for which no other known risk factor was collected

Reported chlamydia infection by year, Oregon and U.S.

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216 Oregon 390 275 U.S. 447

100 200 300 400 500 Rate per 100,000 residents

Oregon Reportable Diseases Database and CDC (U.S. data) Source: 2014 U.S. data not available. Notes:

Progress to date and next steps

• Many examples of work that’s happening that aligns with SHIP

strategies:

– Childhood immunization status and tobacco prevalence incentive measures; – School dental sealant training and certification program; – Youth suicide prevention plan.

• Next steps:

– Continue to work with partners to implement SHIP strategies; – Publish a SHIP progress report in 2016.

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For more information

healthoregon.org/modernization healthoregon.org/ship lillian.shirley@state.or.us (971) 673-1222

Next Meeting: April 22nd at 9AM - noon

Agenda

• Measures by race/ethnicity and language
• Health Share presentation on disparities work
• Information from OEI on language access
• Continued discussion of future program structure (TBD)