Metrics & Scoring Committee January 18, 2019 Todays Agenda - - PowerPoint PPT Presentation

Metrics & Scoring Committee

January 18, 2019

Today’s Agenda

Welcome & general updates Debrief from HPQMC Update on CQMR Planning for 2020 measure set

Review measure retirement checklist Review draft stakeholder survey Identify measure owners Plan for next few months

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

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Review December Minutes

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Health Plan Quality Metrics Committee Update

January meeting overview  Presentation: Metrics and scoring committee recommendations (MORE LATER!)  Discussion: Measure governance  Planning for 2020 measure finalization Next meeting: Feb 14, 2019

• Update: Health Equity Measurement Workgroup

For committee information: http://www.oregon.gov/oha/analytics/Pages/Quality‐Metrics‐ Committee.aspx

HPQMC Update ‐ Measure Governance: Final Guidance

Measure adoption includes the specifications for the measure as they exist when the measure set is released. If the steward makes changes between this time and the start of the measurement year, those changes will be reviewed and reconsidered using the following process.

• If stakeholders or staff note a change in measure intent or measure definition, the measure will

be presented for review and discussion at HPQMC to determine the best next step. Feedback from potential users of this measure will be considered in any final decisions.

• If stakeholders or staff note a change in process or technical specifications, and no change in

measure intent or measurement definition, the measure will stay on the list with the updated specifications made by the measure steward. Operational impacts and changes will be to the discretion of the user that selected the measure.

• Measures that use national HEDIS measures or eCQMs must use the most current HEDIS specs

that apply to the measurement year without adaptation. These are critical to aligned state and federal reporting.

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Developmental Measures Updates

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Obesity Measure Workgroup Update

Goal: Glide path to introduce Component 1/ Multisector Interventions in 2021 (year 1) and add BMI measurement change to the measure in 2023 (year 3) January updates Workgroup A (Community investments in multisector interventions)

• Key criteria and draft technical specifications have been finalized
• NEXT STEPS: Gather feedback from Metrics and Scoring committee and request

CCO organizations who want to pilot test the specifications (February or March)

• Next meeting: Jan 18

Workgroup B (BMI reporting)

• Next meeting: Jan 23 ‐ Kickoff and workplan development for the next two years

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Health Equity Measurement Workgroup Update

December 18, 2018 meeting highlights:

• Workgroup agreed to work toward a short‐term solution for February, then focus on a longer‐

term solution

• Presentation and discussion on potential measure on primary care access by race/ethnicity
• Initial measure criteria: (1) focus on race/ethnicity disparity, and (2) be universally usable by all

CCOs Two meetings in January – 1‐hour check‐in on January 14, full meeting on January 25

• Will look at data for the proposed measure on primary care access and consider its feasibility
• Will also look at existing non‐incentive CCO measures for potential feasibility
• Scheduled to present to HPQMC in February

For more information: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Health‐Equity‐Measurement‐ Workgroup.aspx

Health Plan Quality Metrics Committee Background

• SB 440 of 2015 established Health Plan Quality Metrics Committee (HPQMC)
• Requires HPQMC to develop a menu of health outcome and quality measures for CCOs

and plans offered by PEBB, OEBB, and the Insurance Exchange

• Any metrics used for these plans must be on the menu developed by the Committee
• Metrics & Scoring Committee became a subcommittee of the HPQMC

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Debrief: Metrics & Scoring Proposal to HPQMC (1/3)

• Social Determinants of Health

– Unanimously endorsed shift to broader SDOH (versus just food security) – Discussion included:

• Importance of flexibility about screening tools, but with clear definition of what counts for

metric credit (example of good practice is rollout of developmental screening measure)

• Being thoughtful about number of domains included
• Whether the measure should be at a clinic or plan level (or both)
• Importance of environmental scan to learn from other states’ measurement efforts

– OHA will convene a workgroup to begin developmental work

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Debrief: Metrics & Scoring Proposal to HPQMC (2/3)

• Health Aspects of Kindergarten Readiness

– Unanimously endorsed development of social emotional health attestation measure (plan level measure on social emotional health), and asked that a measure (or measures) be developed that could be used by (a) CCOs and eventually (b) commercial plans – Unanimously endorsed entire measurement strategy (multiple components which build

• ver time)
• Preventive dental visits + well‐child visits
• Social‐emotional health attestation measure
• Follow‐up to developmental screening

– Discussion included:

• The importance of this work beyond Medicaid, and need to take commercial plans into account in

development of social emotional health measure

• That attestation measure could help address payment and policy issues; could discuss with Primary

Care Payment Reform Collaborative, OHLC, etc.

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Debrief: Metrics & Scoring Proposal to HPQMC (3/3)

• Additional areas of interest:

– Suicide – Flu immunizations – Substance use disorders

Public testimony

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Clinical Quality Metrics Registry (CQMR) Update

Kate Lonborg, CQMR Program Manager, OHA

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Refresher: What is the CQMR?

• New streamlined quality reporting solution
• Consolidates eCQM reporting across programs:

– Medicaid EHR Incentive Program – Comprehensive Primary Care Plus (CPC+) (supported) – Merit-based Incentive Payment System (MIPS) (supported) – CCO incentive measures – TBD – additional programs over time

• Collects electronic Clinical Quality Measures (eCQMs) specified for CMS

programs per national standards

– Also will collect state-specific EHR-based CCO incentive measures (smoking prevalence, SBIRT) as aggregated data

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Clinical Quality Metrics Registry (CQMR) Key Dates

• January 14, 2019: Go live for Medicaid EHR Incentive Program to report

2018 eCQMs

• February 1, 2019: Go live for Merit-based Incentive Payment System

(MIPS) and Comprehensive Primary Care Plus (CPC+) support

– If you participate in multiple programs, you may choose to use CQMR to send eCQMs to CMS for MIPS or CPC+ reporting

• TBD: Going live later for CCO incentive measures – plan to use for pilots

ahead of 2019 reporting

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2019 Measure Set Alignment - eCQMs

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Why the focus on eCQMs?

• Used in CMS programs, creating some immediate alignment
• Incorporated into federal certification criteria for EHRs
• Fully specified for reporting electronically (human-readable and machine-

readable)

• Reportable in standardized format at aggregated and patient levels

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Scope of CQMR

• CQMR will start with Medicaid programs already collecting clinical quality

measure data

– Improving processes and usability of the data – Offering technical assistance to help with patient-level data reporting – Not trying to displace existing tools

• Assessing options to support providers in other reporting
• Building the alignment to support “report once” will take time

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Data collection efficiency opportunities

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Providers*

* Options to send via intermediary, such as HIE or registry; API / interface in EHR; Direct; web portal

CQMR OHA programs CMS (CPC+, MIPS) CCOs Other payers

Roadmap

Today and desired future state

Aggregation level

Mostly aggregated Move toward patient-level (QRDA I)

Frequency

• f reporting

Annual Move toward quarterly and then monthly

Participation

Medicaid Expand to support more programs

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Related areas of work:

• Metrics alignment – measures and reporting parameters
• Pilots to combine clinical and claims data

Benefits for Providers and Clinics

Providers and clinics get…

• Single, streamlined tool with multiple submission options
• EHR alignment to reduce need for custom reports and manual data entry
• Glide path to robust data:

– As providers are ready to send patient-level data, system is ready to support drill-down views – Shows how clinics perform against benchmarks – Offers customizable dashboard views

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Benefits to CCOs and Payers

Coordinated Care Organizations get…

• Single, streamlined tool to take in CCO-approved data proposals and

submissions

• EHR alignment for fewer reporting errors and custom reports
• Glide path to robust data:

– Supports more patient-level reporting, as providers are ready – Planned functionality to filter accurately by payer – Supports population health management

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Implementation Update and Next Steps

• Steps Completed: System Testing, User Acceptance Testing (UAT), Security

Testing

– UAT was a 4-week process with about 30 participants from OHA, CQMR Subject Matter Expert Workgroup, and others

• Result: CQMR ready for 2018 Medicaid EHR Incentive Program, but not yet

for CCO incentive reporting

– CCO data proposals and data submissions for 2018 will be submitted as in previous years, with Excel template process

• Next Steps:

– Onboarding Medicaid EHR Incentive Program users – Prepare for CCO use for 2019 reporting and for pilots later this year

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Time for a break

Planning for 2020 measure set selection

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• Review measure retirement checklist (see packet)
• Input on stakeholder survey questions
• Identify measure owners
• Discuss process over next few months

Retirement History

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2015

Follow‐up for children prescribed ADHD medication Early elective delivery

2016

Electronic health record adoption

2017

Claims SBIRT

2018

Follow‐up after hospitalization for mental illness Satisfaction with care (CAHPS)

2019

Timeliness of Prenatal Care

Retirement Checklist

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Metrics & Scoring Committee’s measure retirement checklist was adopted in June 2015 for the Committee’s use when retiring CCO incentive measures. Not all of these criteria must be met before a measure could be retired. Note retired CCO incentive measures may continue as monitoring measures. No additional opportunity for meaningful performance improvement (“topped out”) Measure no longer adds meaningful value Supporting clinical guidelines or evidence‐base have changed Measure has been retired nationally / pending retirement by measure steward Measure cannot be measured

Stakeholder Survey

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• Field in February 2019
• Review findings in March 2019
• Send to stakeholders far and wide; link on Metrics & Scoring

Committee Webpage

• For discussion:
• Focus on measures to drop?
• Include only 19 from 2019, or also three developmental? Any others (e.g.,
• ther SUD from HPQMC menu)?

How to stratify stakeholders?

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Phrasing?

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• Below is phrasing from last stakeholder survey in 2016
• Plans
• Not ask about ‘modify’
• Decision: Does Committee want to ask (1) about why a measure should be kept only

(and justify why), or (2) dropped (and open space to justify why) or (3) justify either?

Measure Owner

• 1. Access to care (CAHPS)
• 2. Adolescent well‐care visits
• 3. Ambulatory care: ED utilization
• 4. Assessments for kids in DHS custody
• 5. Childhood immunization status
• 6. Cigarette smoking prevalence
• 7. Colorectal cancer screening
• 8. Controlling hypertension
• 9. Dental sealants

Jennifer (e.g.)

• 10. Depression screening
• 11. Developmental screening
• 12. Diabetes: HbA1c poor control
• 13. Disparity measure: ED utilization, members with mental illness
• 14. SBIRT
• 15. Effective contraceptive use
• 16. Oral evaluation for adults with diabetes

Jennifer (e.g.)

• 17. PCPCH enrollment
• 18. Timeliness of postpartum care
• 19. Weight assessment, nutrition, and activity counseling

Further Discussion and Next Steps

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February 2019

PIPs and Transformation Quality Strategy (TQS) Review program structure Possible review of measures within draft conceptual framework In‐depth discussion of specific measures? (e.g., any on CCO set? SUD from HPQMC?)

March 2019

Check‐in on proposed

• besity measure for

2021 Presentation on State Health Improvement Plan Priorities Presentation of ‘deeper dive’ report Review findings of stakeholder survey In‐depth discussion of specific measures?

April 2019

Review 2020 HPQMC measures menu In‐depth discussion of which specific measures?

May 2019

Focused discussion of makeup of 2020 incentive measure set

June 2019

Begin formal selection of 2020 measure set

July 2019

Finalize 2020 measure set

Future Meeting Locations

• February 2019: Portland
• March 2019: Wilsonville
• April 2019 on: Portland

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THE FOLLOWING SLIDES ARE INCLUDED AS BACKGROUND, AND WILL ONLY BE REFERENCED IN THE MEETING IF NEEDED

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Supporting Materials

• 2019 incentive metrics by HPQMC framework
• Count of measures by population
• Children (8)
• Adolescents (11)
• Adults (13)
• Older adults (12)
• Count of measures by Sector
• Dental (3)
• Behavioral (2)
• Primary Care (17)
• Specialty (2)
• Hospital (2)
• Public Health (4)

Health Measures Other Measures

Glide Path

Process Outcome 8 – 12 from the following:  Prevention  Childhood  Adulthood  Chronic Disease  Oral Health  Behavioral Health/A&D  Acute/Inpatient Care  Maternity Care 3‐6 from the following:  Satisfaction/Patient Exp.  Social Determinants of Health  Health Equity/Race  Cost/Efficiency  Link to Public Health  Access

Metrics & Scoring Measure Set

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