Metrics & Scoring Committee October 20, 2017 HEALTH POLICY - - PowerPoint PPT Presentation
Metrics & Scoring Committee October 20, 2017 HEALTH POLICY & ANALYTICS Office of Health Analytics Consent agenda Review todays agenda Approve September minutes Written updates (HPQMC next slide) Please note this meeting
HEALTH POLICY & ANALYTICS Office of Health Analytics
October 20, 2017
2
Consent agenda
Review today’s agenda Approve September minutes Written updates (HPQMC next slide)
Please note this meeting is being recorded. The recording will be made available on the Committee’s webpage:
http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-Scoring-Committee.aspx
3
Health Plan Quality Metrics Committee
measures, including hospital measures, maternal health measures, and measures related to asthma
at: http://www.oregon.gov/oha/hpa/analytics/Pages/Quality- Metrics-Committee.aspx
4
Overview: Oregon Public Meetings & State Government Ethics for Public Officials
– Brief overview of Oregon Public Meetings Law – State Government Ethics for Oregon Public Officials – Information in these slides summarized from State of Oregon Overview of Boards, Commissions, & Small Entities (materials and references provided for further information)
Oregon Public Meetings Law
Oregon’s Public Meetings Law serves two purposes: 1.To provide a means by which the public can be informed about the deliberations and decisions of state government; 2.To ensure governing bodies in Oregon have an open decision-making process The Public Meetings Law applies to state and local government “governing bodies” of “public bodies”
Oregon Public Meetings Law
“Public body” includes the state, cities, counties, districts, boards, commissions, committees, subcommittees, advisory groups, and similar bodies. “Governing body” means the members of any public body consisting of two or more members (i.e., a board, commission, committee, subcommittee or council) with authority:
administration
administration
Oregon Public Meetings Law
The Metrics & Scoring Committee is a public body and its meetings are subject to Public Meetings Law. A public meeting includes any deliberations that involve a quorum of Committee members. For M&S a quorum is 5 of the 9 members. Examples of activities that fall under Public Meetings Law include:
Likewise, any subcommittee or workgroup chartered by M&S is subject to Public Meetings Law.
Oregon Public Meetings Law
Four basic requirements for conducting a public meeting
meetings, location, and main subjects
For specific limited purposes public bodies can meet in executive session to have confidential discussions. Executive sessions are closed to the public. Members of the media may attend but cannot report what was discussed. No decisions can be made in executive session.
Oregon Public Officials
There are approximately 200,000 public officials in Oregon:
a state, county, city government, or special district
district
special district
subdivisions Metrics & Scoring Committee members are public officials.
State Government Ethics for Public Officials
Public officials are personally responsible for complying with the provisions in state ethics law. Public officials must make a personal judgment in deciding such matters as
State Government Ethics for Public Officials
Use of Position
Ethics law prohibits using or attempting to use the position you hold as a public official to obtain a financial benefit, if the
available but for the position you hold. Financial benefit can be either an opportunity for gain or to avoid an expense.
State Government Ethics for Public Officials
Gifts
gift offered to you, your relative, or a member of your household, may
interest, gifts are not restricted or prohibited.
definition
to public officials or household members from any single source that could reasonably be known to have a legislative or administrative interest
State Government Ethics for Public Officials
Conflict of Interest
that would affect the financial interest of yourself, your relatives, or a business with which you or your relative is associated.
that could affect the financial interest of yourself, your relatives, or a business with which you or your relative is associated.
State Government Ethics for Public Officials
Conflict of Interest
Public officials met with an actual or potential conflict of interest need to disclose it
nature of the potential conflict prior to taking any action in the capacity
nature of the actual conflict and refrain from participating as a public
actual conflict arises or from voting on the issue.
References
Commissions, & Small Entities
Meetings Law
HEALTH POLICY & ANALYTICS Office of Health Analytics
16
Public testimony
Metrics & Scoring Committee Meeting October 20, 2017
Katrina Hedberg, MD, MPH, State Public Health Officer Cat Livingston, MD, MPH, Associate Medical Director, Health Evidence Review Commission Sara Kleinschmit, MSc, Policy Advisor, Office of Health Analytics
Presentation Overview
focusing specifically on the Medicaid population.
interventions.
Committee, and concerns from partners, including the Health Plan Quality Metrics Committee.
measure.
Source: Oregon Behavioral Risk Factor Surveillance System Note: Vertical dashed line (---) indicates change in survey methods (2010). Estimates are age-adjusted.
11% 29%
0% 5% 10% 15% 20% 25% 30% 35%
1990 1995 2000 2005 2010 2015
Percent obese
Obesity among Oregon adults, 1990-2015
Medicaid
41.3% 38.8% 41.0% 40.1% 42.3% 34.3% 32.4% 31.5% 34.2% 38.8% 36.3% 28.0% 40.8% 34.9% 37.8% 34.9% 0% 10% 20% 30% 40% 50%
Yamhill CCO Willamette Valley Community… Western Oregon Advanced Health Umpqua Health Alliance Trillium PrimaryHealth of Josephine County PacificSource - Gorge PacficSource - Central Jackson Care Connect Intercommunitiy Health Network Health Share of Oregon FamilyCare Eastern Oregon Columbia Pacific Cascade Health Alliance AllCare Health Plan
Percent of Medicaid members who are obese by CCO
Source: 2014 Oregon Medicaid BRFSS
10% 36% 39% 40% 44% 46%
Obesity among Oregon adult Medicaid recipients by race and ethnicity
Pacific Islander American Indian or Alaska Native Latino White Asian
Source: 2014 Oregon Medicaid BRFSS Note: Race and ethnicity categories are mutually exclusive.
African American
7% 13% 7% 11%
0% 4% 8% 12% 16%
2001 2003 2005 2007 2009 2011 2013 2015
Percent
Source: Oregon Healthy Teens Survey
8th graders 11th graders
Obesity among Oregon youth, 2001-2015
16% 15% 14% 15%
0% 18%
2006 2008 2010 2012 2014 2016
Source: Oregon WIC Program Administrative Data Note: Vertical dashed line (---) indicates change in reporting methods (2011) from CDC to state reporting.
Obesity among Oregon WIC Participants Aged 2-5, 2006-2016
Obesity rates peaked in 2010/2011 and have gradually declined
Significant Decrease in Obesity among WIC Children Ages 2-4 in Oregon and Nationally (2010-2014)
Source: Pan L, Freedman DS, Sharma AJ, Castellanos-Brown K, Park S, Smith RB, Blanck HM. Trends in Obesity Among Participants Aged 2-4 Years in the Special Supplemental Nutrition Program for Women, Infants, and Children—United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2016; 65(45).
Population interventions to slow the increase of
Strategy 1: Increase the price of sugary drinks Strategy 2: Increase adoption of standards for healthy foods and beverages, physical activity and breastfeeding in workplaces, agencies, schools, health care settings Strategy 3: Increase access to places for physical activity Strategy 4: Ensure availability of comprehensive chronic disease screening, referral and management benefits through public health plans
multistakeholder representatives
–Behavioral interventions –Pharmacologic interventions –Devices –Bariatric Surgery –“Multisector Interventions”
USPSTF, 2012
months
– lost 1.5 to 5 kg (3.3 to 11.0 lb), or 4% of baseline weight. – Interventions with a greater number of sessions showed more weight loss. – 12 to 26 intervention sessions associated with 4 to 7 kg (8.8 to 15.4 lb) (6% of baseline weight) compared with 1.5 to 4 kg (3.3 to 8.8 lb) (2.8% of baseline weight) in those who participated in fewer than 12 sessions.
weight loss
setting weight-loss goals, addressing barriers to change, and strategizing about maintaining long-term changes in lifestyle.
that diabetes incidence decreased by 30% to 50% over 2 to 3 years (NNT=7)
reduction and maintenance.
Hartmann-Boyce, et al, 2014
– Commercial programs with meal replacements were associated with an average weight loss of 6.83 kg (95% CI -8.39 to -5.26) – Group based commercial programs without meal replacements were associated with an average weight loss of 2.21 kg (95% CI -2.89 to -1.54) – Automated internet-based program were associated with an average weight loss of 0.7 kg (95% CI -1.37 to -0.03) – Primary care-based programs were associated with an average weight loss of 0.45 kg (95% CI -1.34 to -0.43).
– Only group-based commercial programs had persistent benefit – Conclusion: There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.
Booth, 2014
associated with small but statistically significant reduction in weight at 12 months (effect size -1.36 kg, 95% CI -2.10 to -0.63) and 24 months (effect size -1.23 kg, 95% CI -2.28 to -0.18) when compared with controls.
interventions are associated with small reductions in weight that may not be clinically significant.
Franz, et al, 2015
energy intake plans, group behavioral weight management programs, intensive physical activity, and diets with various proportions of carbohydrates, fats, and protein
– Intensive lifestyle intervention group (ILI, as described in the LookAHEAD trial) = 8.6% – Mediterranean diet group = 7.2%
Hartmann-Boyce, 2014
– Programs that included calorie counting, contact with a dietician, and behavioral techniques comparing participants’ behavior with others
Johns, 2014
combined behavioral weight management programs (BWMPs) in obese adults
than both
– diet-only (mean difference -1.72 kg, 95% CI -2.80 to -0.64) – exercise-only programs (mean difference -6.29 kg, 95% CI -7.33 to -5.25)
difference
be the most effective
interventions) may not be effective
What works to slow the increase of obesity in children?
O’Connor, 2017
weight reduction.
more hours of intervention contact are likely to help reduce excess weight in children and adolescents.
1: Clinical interventions (USPSTF)
supports parent-only interventions are as, or more effective than parent- child or child only)
2: Community-level interventions
change strategies
1: School-based interventions, family-based education programs, preschool cooking classes 2: Community-level interventions
marketing, active transportation 3: Policy change
subsidies for unhealthy foods
Obesity Measures Considered by Metrics & Scoring
Child Measure Adult Measure
Title Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan NQF number 0024 0421 Meaningful Use measure? Y Y CMS Merit-based Incentive Payment System measure? Y Y Description % patients aged 3-17 who had an outpatient visit with a PCP or OB/GYN) and had evidence of the following. Three rates are reported.
percentile documentation
activity % patients aged 18+ with a BMI documented AND with a BMI
follow-up plan is documented Detailed specifications
https://ecqi.healthit.gov/ecqm/measures/cms15 5v6 https://ecqi.healthit.gov/ecqm/mea sures/cms069v4
Pros and Cons of MIPS Obesity Measures (child measure chosen by Metrics & Scoring)
Pros Cons
vetted value sets
incentive programs
benchmarking
meaning they are relatively ‘ready to go’ in terms of reporting
their EHRs without extensive EHR-builds (will still require some work at clinic level to report for Medicaid population only, and possibly
interventions shows that low intensity interventions are ineffective in reducing obesity
evidence review and multistakeholder Obesity Task Force
Health Plan Quality Metrics Committee
Committee doesn’t endorse child measure, CCOs will have worked to report on a measure for only one year
Obesity Metric Components and Optimization
The current proposed obesity metric includes
–BMI reporting
–PCP documentation about obesity counseling
necessary to yield health benefits.
Path Forward: Proposal (1/3)
an evidence-based measure.
1. Propose the current child obesity metric (NQF 0024) to get BMI reporting up to standard.
– Is evidence that this measure contributed to increased rates of BMI percentile assessments (33.7 percentage points), counseling for physical activity (18.6 percentage points), and counseling for nutrition (21.0 percentage points) among youth ages 3-17 year enrolled in Medicaid over the period 2009- 20141. – While these actions in and of themselves are shown to be ineffective in addressing obesity in children (per HERC evidence review), these clinical assessments (particularly BMI assessment) are a first step in identifying children in need of
– The measure could ensure that reporting systems are in place for an evidence-based measure.
1 National Committee for Quality Assurance. (2016). The State of Health Care Quality Report 2015 from Building a Culture of Health in
Childhood Obesity: Overview & Action Plan for Medicaid Health Plans. (2016). Robert Wood Johnson Foundation. http://www.medicaidinnovation.org/_images/content/final_chopt_toolkit.pdf
Path Forward: Proposal (2/3)
staff bring together internal and external subject matter experts to develop evidence-based child and adult measures.
– Elements of the evidence-based measure could include:
children, 12 encounters for adults)
Path Forward: Proposal (3/3)
involving check-ins with both Metrics & Scoring and the HPQMC as the measures are developed.
2018 (with the child obesity measure), but would address the HPQMC’s concerns in that there is a clear glide path towards evidence-based, obesity outcome measures.
glide path for presentation to the HPQMC?
glide path to the HPQMC?
46
Smoking prevalence measure – Background
(approximately 36%) compared to commercially insured individuals (approximately 13%)
prevalence (outcome) rather than screening and follow- up (process)
an opportunity to use that measure to calculate tobacco prevalence for patients aged 18+
Components and Scoring of Smoking Prevalence Measure
http://www.oregon.gov/oha/HPA/ANALYTICS/CCOData/Cigarette%20Smoking%20Prevalence%20Bu ndle%20-%202017.pdf http://www.oregon.gov/oha/HPA/ANALYTICS/CCOData/Cigarette%20Smoking%20Prevalence%20Bundle%20- %202017.pdf
Smoking Prevalence Measure – EHR- based prevalence data
Tobacco Use: Screening and Cessation Intervention (2018)
Federal Programs Using Tobacco Use: Screening and Cessation Intervention
Key Differences between the Measures
– Age 13+ for CCO measure – Age 18+ for NQF0028/ CMS138
– Medicaid only for CCO measure – All payers for NQF0028/ CMS138
– Separate reporting of these rates in CCO measure – No separate reporting of smoking in NQF0028/ CMS138
2016 Smoking Prevalence Measure –
Differences between Adults and Adolescents
adolescent v adult rates -- comparison through patient-level data reports adolescents adults total screened 5736 47604 total smokers 162 16799 total tobacco users 160 17033 smoking rate 2.8% 35.3% total tobacco rate 2.8% 35.8%
Smoking prevalence measure – decisions
NQF0028/ CMS138 to assess tobacco prevalence for patients aged 18+ beginning in 2019?
cessation benefit as part of measure in 2019?
55
PCPCH Measure Context and Proposal
CCOs in contracting with tribal clinics.
short-term because many of these clinics do not yet have PCPCH recognition.
this work is under way, and as CCOs work with tribal clinics to earn PCPCH
2019.
– See data on next slide
– Data caveat:
performance improvements, as the numerator has not been altered.
work with CCOs to ensure tribal members are excluded from numerator calculations.
PCPCH Measure Context (*numerator unaltered*)
CCO Reported
OHA- calculated CCO enrollment Original PCPCH Enrollment (OHA denominator) CCO HNA Jun 2017 CCO total non- HNA enrollment Adjusted PCPCH rate (w/ non-HNA enrollment) Dif Rate AllCare 7/12/17 48103 64.3% 1,034 47,093 65.6% 1.4% Cascade 7/11/17 16425 51.4% 536 15,880 53.2% 1.8% Columbia Pacific 7/24/17 23527 56.4% 447 23,083 57.5% 1.1% Eastern Oregon 8/1/17 47606 63.1% 1,568 46,049 65.2% 2.1% FamilyCare 7/28/17 114626 69.0% 1,751 112,855 70.1% 1.1% Health Share 7/21/17 206451 69.5% 3,394 203,015 70.7% 1.2% IHN 7/31/17 52070 64.4% 1,204 50,876 65.9% 1.5% Jackson 7/24/17 28970 60.4% 550 28,418 61.6% 1.2% PacificSource - Central 7/31/17 49001 71.8% 1,094 47,911 73.4% 1.6% PacificSource - Gorge 7/31/17 12361 63.1% 261 12,101 64.4% 1.4% PrimaryHealth 8/11/17 9855 85.3% 201 9,662 87.0% 1.7% Trillium 7/25/17 86452 41.5% 1,900 84,561 42.4% 0.9% Umpqua 7/28/17 26120 62.9% 553 25,574 64.2% 1.3% WOAH 8/10/17 19177 53.4% 476 18,703 54.8% 1.4% WVCH 8/11/17 94575 57.2% 2,047 92,506 58.5% 1.3% Yamhill 7/31/17 23063 61.6% 452 22,599 62.9% 1.3% Statewide Totals 858382 62.7% 17,468 840,886 64.0% 1.3%
58
59
Health Plan Quality Metrics Committee Overview (1/2)
measures for CCOs (quality pool), and health benefit plans sold through the health insurance exchange or offered by PEBB or OEBB
HPQMC
exchange, PEBB, and OEBB) choose metrics for 2019+
process for revisiting is TBD
60
HPQMC Overview (2/2)
– Utilize existing state and national measures – Are not prone to random variations based on the size of the denominator – Utilize existing data systems to the extent practicable – Can be meaningfully adopted for a minimum of three years – Use a common format in the collection of the data – Can be reported in a timely manner
account the recommendations of the Metrics & Scoring Committee and differences in the populations served by CCOs and commercial insurers.
presented to the HPQMC in November
61
HPQMC Measure Selection Criteria
Criteria for Individual Measures
recommended
public reporting of the data
62
HPQMC Measure Selection Criteria
Criteria for Measure Set as a Whole
63
HPQMC Domains and Candidate Measures
– Access – Acute Care – Behavioral Health – Chronic Illness Care – Inpatient Care – Maternity Care – Oral Health – Overuse / Waste – Patient Experience
materials packet *note this list is not complete; Bailit Health is compiling the list as each domain is discussed by the HPQMC
64
Discussion
recommendations document
– Is the rationale for each measure accurate? Changes needed? – Is recommendation the 2018 measure set + all, or subset of “on deck” measures? – Approach for ‘on deck’ measures – comprehensive or targeted, intentional recommendation? – Others?
65
66