Metrics & Scoring Committee September 15, 2017 HEALTH POLICY - - PowerPoint PPT Presentation

Metrics & Scoring Committee

September 15, 2017

HEALTH POLICY & ANALYTICS Office of Health Analytics

Consent agenda

 Review today’s agenda  Approve August minutes  Written updates (HPQMC next slide)

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Health Plan Quality Metrics Committee

• Met September 14th and continued review of candidate

measures

• Next meeting: October 12, 2017, 1.30-4.00
• Meeting information and materials are available online

at: http://www.oregon.gov/oha/hpa/analytics/Pages/Quality- Metrics-Committee.aspx

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Vice-Chair elections

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HEALTH POLICY & ANALYTICS Office of Health Analytics

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Public testimony

Finalize selection of 2018 benchmarks & improvement target floors

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Recap: Benchmark decisions from last meeting (1/2)

Measure Benchmark Improvement target

Access to care (CAHPS) TBD, 2017 national Medicaid 75th percentile for (a) adults and (b) children; must achieve benchmark/improvement target on both for metric credit MN method with 2 percentage point floor Adolescent well-care visits TBD, 2017 national Medicaid 75th percentile (admin data) MN method with 2 percentage point floor Ambulatory care: Emergency department utilization TBD/1,000 member months 2017 National Medicaid 90th percentile MN method with 2 percent floor Assessments for children in DHS custody 90%, Committee consensus MN method with 3 percentage point floor Childhood immunization status TBD, 2017 National Medicaid 75th percentile MN method with 2 percentage point floor Cigarette smoking prevalence 25%, Committee consensus MN method with 1 percentage point floor

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Recap: Benchmark decisions from last meeting (2/2)

Measure Benchmark Improvement target

Colorectal cancer screening 54.0%, 2016 CCO 90th percentile MN method with 2 percentage point floor Controlling hypertension TBD 2016 National Medicaid 90th percentile MN method with 2 percentage point floor Dental sealants on permanent molars for children 22.9%, 2016 CCO 75th percentile MN method with 3 percentage point floor Depression screening and follow-up plan 63.0%, 2016 CCO 90th percentile MN method with 3 percentage point floor Developmental screenings in the first 36 months of life 74.0%, 2016 CCO 90th percentile MN method with 3 percentage point floor Patient-centered primary care home enrollment N/A – sliding scale with 60% threshold N/A

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Remaining 2018 Benchmark Decisions

• Diabetes HbA1c poor control
• Effective contraceptive use

– Note previous changes to 2018 specifications

(1) permanent numerator credit for tubal ligations; (2) including adolescents in incentivized part of measure

• Timeliness of prenatal care
• Child obesity – BMI, nutrition and activity counseling
• ED utilization among members experiencing mental

illness

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Who is in the denominator?

Women who are abstinent Women who partner with women Women who are trying to conceive (i.e. women who don’t need contraception) Women who are physiologically capable of getting pregnant, are currently sexually active with men and do not want to get pregnant (i.e. women who need contraception) 70% 30%

Benchmark 50%

Excluded Women with a hyst/ooph in past 7 years paid by Medicaid Women who were pregnant in the measurement year who did not also receive contraception Trouble spots Women who had a hysterectomy or tubal more than 7 years ago Women with a hysterectomy or tubal not paid by Medicaid Women with a partner who has a vasectomy

2016 Statewide P Performance, b by R Report Type

Reporting Mix Depression Hypertension Diabetes Statewide 48.0% 65.9% 25.4% Statewide – Medicaid reporting 51.1% 66.4% 27.8% Statewide – All payer reporting 41.8% 65.4% 23.1%

Time for a break.

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Public health accountability metrics

Opportunities for collaboration between CCOs and public health

September 15, 2017

PUBLIC HEALTH DIVISION Office of the State Public Health Director

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2017-19 investment from the legislature

• The Legislature included $5 million in the OHA budget for public

health modernization.

• The majority of this investment will be used to fund regional

approaches for communicable disease control and reducing health disparities.

• Funds remaining with OHA will be used to enhance population

health surveillance and data system.

PUBLIC HEALTH DIVISION Office of the State Public Health Director

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PUBLIC HEALTH DIVISION Office of the State Public Health Director

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Public health accountability metrics

• In June, the Public Health Advisory Board adopted a set of eight

accountability metrics for the public health system. These metrics will be used to:

– Track progress toward the modernization of Oregon’s public health system; – Bring focus to Oregon’s population health priorities; – Highlight areas where public health and other sectors can work together to achieve shared goals.

• These metrics are not tied to local public health funding at this time

but may be in the future.

• OHA will publish a public health accountability metrics report

annually, beginning in 2018.

PUBLIC HEALTH DIVISION Office of the State Public Health Director

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Public health accountability metrics

PUBLIC HEALTH DIVISION Office of the State Public Health Director

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* Aligns with CCO or early learning priority

Guiding Principles for public health and health care collaboration

• We will not see meaningful improvement in population health without

cross-sector collaboration.

• Direct services to individuals, including clinical interventions, are

supported by the public health system’s focus on prevention; policy, systems and environmental change; and evidence-based strategies to improve population health.

• Public health and health care must work together to ensure that

every community member has access to high quality, culturally appropriate health care. This requires jointly developing and implementing solutions to address access and quality barriers.

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PUBLIC HEALTH DIVISION Office of the State Public Health Director

Immunizations

Public Health Work Outreach/homevisits

• Imms assessment
• Patient Education
• Administration
• Reporting
• Promotion
• School exclusion

CPCCO Work: (Clinical)

• Education: provider &

member

• Workflows
• Messaging
• Advocacy
• Incentives
• Analytics/QI
• Barrier: Access

SHARED

• Advocacy
• Pt Education
• Promotion
• Data: Access, Actionable,

Timely

• Key community

stakeholders PH/CPCCO Leads:

Reporting Goal: minimum increase of 5% for each county: Priority: Increase <2y/O & Decrease School Exclusions

Timelines and deadlines…

Columbia Pacific CCO framework for collaborating with local public health departments

Discussion

• How are the public health accountability metrics relevant to this

committee’s work?

• How can the Metrics and Scoring and PHAB committees work

together to support infrastructure for collaborations between public health and the health care system?

• What opportunities exist now to develop or build upon existing

collaborations?

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PUBLIC HEALTH DIVISION Office of the State Public Health Director

Health Plan Quality Metrics Committee:

Metrics & Scoring Recommendations for 2019

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Health Plan Quality Metrics Committee Overview (1/2)

• Established by SB 440 of 2015
• Charged with identifying health and outcome quality

measures for CCOs (quality pool), and health benefit plans sold through the health insurance exchange or offered by PEBB or OEBB

• Metrics & Scoring Committee is now a subcommittee of the

HPQMC

• The HPQMC is in the process of identifying a “master list”
• f measures from which Metrics & Scoring (and the

exchange, PEBB, and OEBB) choose metrics for 2019+

• The ‘master list’ will be revisited by the HPQMC annually;

process for revisiting is TBD

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HPQMC Overview (2/2)

• Legislation tasks HPQMC to “prioritize” measures that:

– 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

• Charter and legislation stipulate that the HPQMC must take into

account the recommendations of the Metrics & Scoring Committee and differences in the populations served by CCOs and commercial insurers.

• Metrics & Scoring Committee formal recommendations will be

presented to the HPQMC in November

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HPQMC Measure Selection Criteria

Criteria for Individual Measures

• 1. Utilize existing state and national measures, including measures…
• a. that have been adopted or endorsed by other state or national
• rganizations, and
• b. have a relevant state or national benchmark
• 2. Is statistically sound across the population size for which its use is

recommended

• 3. Utilize existing data systems for reporting the measures
• 4. Present an opportunity for performance improvement
• 5. Can be meaningfully adopted for a minimum of three years
• 6. Use a common format in the collection of the data and facilitate the

public reporting of the data

• 7. Can be reported in a timely manner and without significant delay
• 8. Promote increased value to providers, patients, and purchasers

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HPQMC Measure Selection Criteria

Criteria for Measure Set as a Whole

• 1. Are representative of the array of services that affect health
• 2. Are representative of the diversity of patients served by the program
• 3. Are collectively parsimonious (set is limited in number of measures)
• 4. Include measures with transformative potential

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HPQMC Domains and Candidate Measures

• HPQMC Identified Domains

– Access – Acute Care – Behavioral Health – Chronic Illness Care – Inpatient Care – Maternity Care – Oral Health – Overuse / Waste – Patient Experience

• For current “long list” of candidate measures, see meeting

materials packet *note this list is not complete; Bailit Health is compiling the list as each domain is discussed by the HPQMC

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Discussion

• See draft Metrics & Scoring Committee HPQMC

recommendations document

• To discuss:

– 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?

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Next Meeting: October 20, 2017

• Finalize HPQMC recommendations

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