Metrics & Scoring Committee 16 June 2017 HEALTH POLICY & ANALYTICS Office of Health Analytics
Consent Agenda Review today’s agenda Approve May minutes Written updates (HPQMC on next slide) 2
Health Plan Quality Metrics Committee • Fourth meeting occurred Thursday, June 8 o Agenda included Committee vision; identifying measure selection criteria and selection decision process; and identifying domains for measure sources. • Scheduled to meet monthly (second Thursdays) through 2017 http://www.oregon.gov/oha/analytics/Pages/Qua lity-Metrics-Committee.aspx 3
Public testimony 4
Childhood Immunization Status • Several CCOs are requesting that Childhood Immunization Status be removed from the 2016 incentive measure set. This would impact the June 2017 payments: o Currently (including Childhood Immunization Status in the measure set), 7 CCOs are earning 100% of their quality pool. o If this measure is excluded, 10 CCOs would earn 100% of their quality pool. • Concerns center around revisions to the 2016 rates and improvement targets made as a result of the validation process, as well as the individual- level data shared with CCOs. 5
Childhood immunizations timeline ALERT data Metrics results published 2016 targets • Released ALERT detail data the first time, with CY2015 period. • Data only include members turned age 2 or 13 in the year, who are also Mar. 2016 enrolled with the CCO in December 2015. • Preliminary CY2015 CIS & IMA measure results are included in the dashboard. • Released ALERT detail data Jun. 2016 • Included all members age under 18 who are enrolled with the CCO in December 2015. Final CY2015 CIS & IMA results included in the dashboard. Jun. 2016 •
• Released ALERT detail data through June 2016, age under 18 who are enrolled Sep. 2016 with the CCO in June 2016. • CCO noticed missing members who were dis-enrolled before June 2016. • Midyear-2016 CIS & IMA results are included in the dashboard , including Oct. 2016 member-level detail and 2016 targets . • Published revised CY2015 and mid-year 2016 CIS and IMA results including Nov. 2016 member-level numerator/denominator files. There are two changes in this revision: 1. NOT to exclude member who had no records found in ALERT; 2. Corrected the continuous enrollment algorithm to be based on the child’s date of birth (previously anchored to the end of the measurement period). • Revised CY2015 and midyear-2016 CIS and IMA results incorporated in dashboard; Dec. 2016 member-level detail and revised 2016 targets included.
• Released ALERT detail data through November 2016 , for member age under 18 Jan. 2017 and enrolled with the CCO in November 2016. • Preliminary CY 2016 CIS and IMA results are released . May 2017 • This also includes a code refinement to incorporate the HEDIS 14-day rule. CY2015 results are re-calculated and 2016 targets are re-based . • Also released ALERT detail data through December 2016 (with CCO calendar year claim submission incorporated). • A correction was made to include all members age under 18 enrolled with the CCO anytime throughout 2016; all members qualified for the measure due to continuous enrollment through the birth date are included. June 2017 Final CY 2016 CIS and IMA results are released . • This also includes a code refinement to correct for the leap year (yielding • a .4% increase statewide, and moving one CCO beyond its improvement target to qualify for measure). No change to improvement targets •
Childhood Immunization Status - Decision • In light of the concerns of some CCOs, does the Metrics & Scoring Committee want to exclude Childhood Immunization Status from the 2016 incentive measure set? 9
2018 TAG and OHA staff recommendations 10
Background • The TAG was consulted regarding feedback received in the stakeholder survey, as well as current discussions from the Committee ( see TAG recommendation document in materials). • Areas in which the TAG is suggesting changes for 2018, where there was not consensus, or which relate directly to changes the Committee is considering, are included in the following slides. • Where appropriate, OHA staff recommendations are also included in the following slides. 11
Dental Sealants • Include sealants provided in previous years for children in the denominator – Some argue that the current specs incentivize reapplying sealants just to get measure credit, even if it’s not clinically necessary. – At TAG request, OHA calculated rates looking back two, rather than one year (see materials) 12
Dental Sealants • Add exclusion for patients who are not clinically indicated to need sealants (e.g., at low risk) – There were conflicting opinions from TAG participants about the merits of risk coding. – OHA commissioned an analysis from Q Corp, which showed that, while risk coding is increasing, still only 5% of kids have been coded. – Could be implemented in two ways (see materials): • Per DQA specifications, only including children coded as elevated risk in denominator (decreases denominator by 66% or 87k children in CY 2015 and raises performance 11%). • Only exclude children at low risk, (very few children would be excluded based on current coding rates). CY 2015 (below) shows drop in rate Numerator Denominator Rate Total (Current Specifications) 24,371 132,071 18.5% Low risk (D0601) 1,812 4,847 37.4% Rate After Removing Low Risk Patients* 22,559 127,224 17.7% 13
Dental Sealants - TAG recommendation • TAG recommendation • OHA staff recommendation Lack of consensus related to both look back period and exclusion for those not clinically indicated to need sealants. OHA staff recommendation 1. Include dental sealants in 2018 incentive measure set, but without changes to specifications. Rationale: Sealants are an effective and evidence-based strategy to prevent caries in children, and CCOs have been showing initial improvements and building infrastructure in this area. 2. Add a preventive dental utilization metric for adults. Rationale: The current oral health metrics (sealants and foster care) are limited to focus on children; adding a metric to focus on the adult population encourages integration and improves access to dental care for adults. 14
Developmental Screening • Modify measure to include “follow-up” component: Referral to specialist/services – TAG members expressed concern with availability of timely follow up in some geographies. – Incorporating a “follow-up” component could lead to small denominators. – This information could be difficult to extract from an EHR. TAG recommendation No change for 2018, but consider this modification in the future as we move forward with CQM registry. OHA staff recommendation Concur with TAG; include in 2018 incentive measure set, but without change to specifications. However, create workgroup to explore follow-up component. Rationale: After consulting with TAG and subject matter experts, change not feasible for 2018; however, work group could craft something for inclusion in future years . Subject matter experts also confirmed that shifting the age range would be infeasible and clinically inappropriate. 15
Effective Contraceptive Use • Modify specifications to include permanent numerator credit for tubal ligation. TAG recommendation Modify as above for 2018. OHA staff recommendation Concur with TAG; modify to include permanent numerator credit for tubals. Rationale: Conforms with intent of measure and appropriately confers credit for access to effective contraception. 16
Follow Up After Hospitalization for Mental Illness • Modify to accommodate documented patient refusal, particularly as it relates to small denominators. – OHA has previously denied this modification for the HTPP program. – TAG expressed concern that there needs to be enough flexibility to accommodate a reasonable rate of refusal. For CCOs with small denominators, if one person refuses it can cause them to miss the measure. TAG recommendation Modify measure as above and consider how to address small denominator issue if measure continues in program. OHA staff recommendation No modification to measure if Committee chooses to continue it for 2018. Rationale: Consistent with how treated in HTPP program; no such exclusion exists in HEDIS specifications. 17
Time for a break. 18
Equity Measure – ED Use Amongst Those with SPMI 19
Adults living with serious mental illness die 25 years earlier than other Americans, largely due to treatable medical conditions 20
Aver verage e life fe exp expec ectancy y People with serious mental illness: General population: 49-60 years 78.8 years (depending on where they live) Xu, et al, NCHS Data Brief 2016 Colton and Manderscheid, 2006 Preventing Chronic Disease: Public Health Research, Practice and Policy 21
Caus auses es of of deat eath Peo eople e wit ith ser erio ious men ental l illn illness (co (compared ed to gen gener eral l popul ulati ation) on) Cardiovascular disease Higher rates of Diabetes: 2-3 time higher Breast cancer 10 percent higher Digestive cancer in people with Schizophrenia (most studied co-morbidity) Looking at 2016 OHP claims data, diabetes is higher among members with SPMI: References: Brown, et al, 2000 BJ of Psychiatry Osby et all, 2000 Schizophrenia Research Holt and Peveler, 2005 Diabetic Medicine 22
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