Metrics & Scoring Committee October 19, 2018 HEALTH POLICY - - PowerPoint PPT Presentation

Metrics & Scoring Committee

October 19, 2018

HEALTH POLICY & ANALYTICS Office of Health Analytics

Today’s Agenda

Welcome State of public health in Oregon and opportunities for incentive measures to aid in improvement HPQMC recommendations and strategic planning for measure set:

• Discuss aims of incentive measure set
• Move from broader aims to specific measures that meet that aim (including

review of HPQMC menu set)

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 September Minutes

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Health Plan Quality Metrics Committee Update

Met Thursday, 11 October

• Discussed recommendations for Health Equity Measurement Workgroup
• Discussed 2018-19 workplan (menu framework and measure criteria)
• Received update on work of Health Aspects of Kindergarten Readiness Technical

Workgroup

Next meeting: Thursday, 8 November

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

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Measure Development Work

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Health Aspects of Kindergarten Readiness

• Sought feedback from TAG (27 September) and provided an update to the HPQMC on

progress (11 October).

• TAG noted concerns with using a multi-part bundle metric; value in rolling out different

metrics at different time periods; and, value of metrics for 0-5 population given life course perspective.

• Next meet 26 October and 5 November
• Will incorporate input from Metrics & Scoring Committee, TAG, Early Learning Hubs,

health care providers (including primary care), HPQMC, and other stakeholders

• Will explore and refine measure recommendations
• Present recommendations to Metrics & Scoring Committee on 16 November
• The Metrics & Scoring Committee may then choose to carry some or all of these

recommendations to the HPQMC in January 2019.

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Measure Development

• Obesity Metric Workgroup
• Will provide substantive update to Metrics & Scoring Committee in November.
• If Metrics & Scoring Committee supports proposal, would look to Metrics & Scoring

Committee to ‘carry’ initial proposal to HPQMC in early 2020 for inclusion in 2021 HPQMC measures menu.

• Additional components which require a longer development period (EHR-based), would

be proposed in 2021, for inclusion on 2022 HPQMC measures menu.

• Health Equity Measurement Workgroup
• Co-chaired by Jon Collins and Leann Johnson, both of OHA. Will Brake from Metrics &

Scoring Committee is a workgroup member.

• First meeting end of October.
• May propose measures for inclusion in 2020 HPQMC measures menu; potential for

additional measures to be proposed in future years (i.e., 2021+ HPQMC menu).

• As not created at request of Metrics & Scoring Committee, would not look to Metrics

& Scoring Committee to carry proposals to HPQMC.

Standing Update – CCO 2.0

~see straw model in packet; presented to OHPB at August meeting~

Anona Gund, OHA

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Public testimony

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OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division

Oregon’s health priorities:

Recommendations to the Metrics and Scoring Committee on areas of unmet need

Katrina Hedberg, MD, MPH Health Officer and State Epidemiologist Lisa Bui, MBA Quality Improvement Director October 19, 2018

Purpose for today’s discussion

• Highlight opportunities for improvement in state health priorities through CCO

metrics

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State Health Improvement Plan (SHIP) Priorities, 2015- 2019

• Reduce tobacco use
• Slow the increase of obesity
• Reduce the harms associated with alcohol and substance use
• Improve oral health
• Prevent deaths from suicide
• Improve immunization rates
• Protect the population from communicable disease

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Currently in M&S Measurement Set: Prevent and Reduce Tobacco Use

SHIP priority targets Decrease:

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

CCO incentive metric

• Cigarette smoking prevalence

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Currently in M&S Measurement Set: Prevent and Reduce Obesity

SHIP priority targets Decrease

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

CCO incentive metric

• Weight assessment and counseling in children and adolescents
• Glide path workgroup started for an evidence-based metric

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Currently in M&S Measurement Set: Improve oral health

SHIP priority targets Decrease

• Third graders with cavities in their permanent teeth
• Adolescents who have ever had a cavity
• Prevalence of older adults who have lost all their natural teeth

CCO incentive metrics

• Dental sealants on permanent molars for children
• Oral evaluation for adults with diabetes

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Currently in M&S Measurement Set: Improve immunization rates

SHIP priority targets Increase:

• Rate of 2-year-olds who are fully vaccinated
• HPV vaccination series rate among 13- to 17-year-olds
• Seasonal flu vaccination rates in people ≥6 months of age

CCO incentive metric

• Childhood immunization status (combo 2)

Also on HPQMC list: Immunizations for adolescents (combo 2)

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Gaps in Measurement: Reduce harms associated with alcohol and substance abuse

SHIP priority targets Decrease

• Prescription opioid mortality
• Alcohol-related motor vehicle deaths

CCO incentive metric

• Screening, Brief Intervention and Referral to Treatment

(SBIRT) for drugs and alcohol use

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Opioid overdose mortality by year, Oregon

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Alcohol-related deaths by year, Oregon

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Alcohol-related deaths by age and sex; Oregon, 2016

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Adult binge drinking by sex and year

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Key strategies for reducing harms from alcohol and substance use disorders

Population interventions

• 1. Increase the price of alcohol

Health system interventions

• 1. Incentives for alcohol and substance use screening, treatment and

prevention

• a. CCO incentive measure: screening and referral to treatment for alcohol
• r other substance use disorders (SBIRT)
• 2. Reduce high risk opioid prescribing
• a. Statewide PIP
• 3. Ensure access to evidence-based pain management
• 4. Ensure access to alcohol and substance use disorder treatment

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Gaps in measurement: prevent deaths from suicide

SHIP priority targets Decrease

• Rate of suicide
• Suicide attempts among 8th graders
• Emergency department visits for suicide attempts

CCO incentive metric

• Depression screening and follow up plan

HPQMC list

• Follow up after hospitalization for mental illness

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Suicide deaths by year, Oregon and US

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Suicide deaths by age and sex, Oregon

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Key strategies for suicide prevention

Population interventions

• 1. Promote use of the National Suicide Prevention Lifeline
• 2. Ensure communities implement services and programs to promote safe and

nurturing environments Health system interventions

• 1. Adopt incentive measures for suicide prevention

a) CCO incentive measure: Depression screening and follow up plan b) State performance measure: Follow-up after hospitalization for mental illness

• 2. Establish universal screening for individuals at risk of suicide

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Gaps in measurement: protect the population from communicable diseases

SHIP priority targets Decrease:

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

10 years CCO incentive metric None

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HIV diagnoses and deaths, Oregon

Racial disparities in HCV outcomes, Oregon, 2009-2013

Liver Cancer Deaths Chronic HCV

Chlamydia rates

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Key strategies for communicable disease control

Population interventions

• 1. Reduce non-judicious antibiotic prescriptions

Health system interventions

• 1. Adopt incentives for communicable disease control

a) State performance measure: Percent of two year-olds who received recommended vaccines b) HPQMC measure: Chlamydia screening c) HPQMC developmental measure areas for HIV and hepatitis C screening

• 2. Promote use of expedited partner therapy by health care providers

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Recommended Area of Focus

State Health Improvement Plan (SHIP) Priorities, 2015-2019

• Reduce tobacco use
• Slow the increase of obesity
• Reduce the harms associated with alcohol and substance use
• Improve oral health
• Prevent deaths from suicide
• Improve immunization rates
• Protect the population from communicable disease

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Alignment to Quality

• Community Health Improvement Plans

– Areas of Focus: Clinical, Public Health, Social, Equity

• Transformation and Quality Strategy (TQS)

– Key Components: Integration, Value Base Payment models, Oral Health, Utilization, Complaints and Grievance

• Performance Improvement Projects

– Statewide PIP

• 2016-2019: Chronic Opioid use reduction strategies
• 2019-2021: Appropriate Acute Prescribing of Opioids

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Next Steps

• M&S can explore alcohol and substance abuse potential measures and advocate

to HPQMC for inclusion into 2020 menu

• M&S can consider adopting HPQMC- approved measures for adolescent

immunizations, chlamydia screening, and follow up after hospitalization for mental illness Questions: OHA.Qualityquestions@state.or.us

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Ti Time e for a a brea eak

HPQMC Recommendations and Strategic Planning for 2020+ Measure Set

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Conversation Goals

• Any Committee recommendations for the 2020 HPQMC

measures menu

• Must make recommendations to HPQMC in January 2019.
• Committee workplan through June 2019, when you select

2020 incentive measure set

• Goals of measure set
• Review current measure set in relation to those goals
• Any measures from HPQMC 2019 list to explore through June, for potential

inclusion in 2020 CCO incentive measures

• Also, review of program structure

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Supporting Materials

• Performance on all CCO measures (see state quality quilt in packet)
• Full HPQMC Menu with 2019 incentive metrics highlighted in blue (see packet)
• 2019 incentive metrics by HPQMC framework (see packet)
• Count of measures by population
• Children (8)
• Adolescents (11)
• Adults (13)
• Older adults (12)
• Additional materials (see slides at end of presentation as needed)
• Governor’s health care agenda
• Medicaid waiver goals
• OHA/waiver goals from Governor
• Metrics & Scoring Committee Measure Selection Criteria
• Count of measures by Sector
• Dental (3)
• Behavioral (2)
• Primary Care (17)
• Specialty (2)
• Hospital (2)
• Public Health (3)

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Aims of Incentive Measure Set as a Whole

• For consideration / discussion:
• What does Committee want the whole measure set to do?
• Does Committee want a measure set that keeps a balance across all

domains?

• Or, does Committee want a measure set that focuses on a problem it

wants to solve (e.g., substance use)?

• Does Committee want to spur action in a certain area, or have a measure

set that provides a broad snapshot of the whole realm of care in Medicaid?

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

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Governor’s Health Care Strategies

• 1. Ensure Oregonians’ access to health insurance coverage
• 2. Improve overall health outcomes through CCO 2.0
• 3. Control long-term cost growth in health care spending
• 4. Use reinsurance to keep rates affordable in the private market
• 5. Increase investments in mental health and addiction prevention and treatment
• 6. Modernize public health
• 7. Increase capacity, retention, and diversity in Oregon’s health care workforce
• 8. Create better health through good jobs

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Waiver Goals

Governor’s Direction for CCO 2.0 Waiver - Four Key Goals (p. 10) Increasing value-based payment Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health- related services, advances the use of value-based payments; Focus on social determinants of health and equity Increase the state’s focus on encouraging CCOs to address the social determinants

• f health and improve health equity across all low-income, vulnerable Oregonians

to improve population health outcomes; Maintaining a sustainable rate of growth Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health- related services, advances the use of value-based payments; Improving the behavioral health system Enhance Oregon’s Medicaid delivery system transformation with a stronger focus

• n integration of physical, behavioral, and oral health care through a performance-

driven system aimed at improving health outcomes and continuing to bend the cost curve; Expand the coordinated care model by implementing innovative strategies for providing high-quality, cost-effective, person-centered health care for Medicaid and Medicare dual-eligible members.

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Measure Selection Criteria (1/2)

Technical Measure Criterion

1. Evidence-based and scientifically acceptable 2. Has relevant benchmark 3. Not greatly influenced by patient case mix

Program-Specific Measure Criterion

• 4. Consistent with goals of program
• 5. Useable and relevant
• 6. Feasible to collect
• 7. Aligned with other measure sets
• 8. Promotes increased value
• 9. Present opportunity for QI
• 10. Transformative potential
• 11. Sufficient denominator size

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Measure Selection Criteria (2/2)

Measure Set Criteria

• 12. Representative of the array of services provided by the program
• 13. Representative of the diversity of patients served by the program
• 14. Not unreasonably burdensome to payers or providers

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

Future Meeting Locations

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• November 2018: Wilsonville
• December 2018: If not cancelled, downtown

Portland (or shorter webinar?)

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

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Wrap-Up Next Meeting: November 16, 2018 in WILSONVILLE

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