Metrics & Scoring Committee December 14, 2018 Todays Agenda - - PowerPoint PPT Presentation

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Metrics & Scoring Committee December 14, 2018 Todays Agenda - - PowerPoint PPT Presentation

Aug 19, 2023 462 likes •857 views

Metrics & Scoring Committee December 14, 2018 Todays Agenda Welcome Vote vicechair Updates Depression screening and followup decisions for 2019 Update on 2019 quality pool amount Planning for 2020 measure set

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Metrics & Scoring Committee

December 14, 2018

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Today’s Agenda

Welcome Vote vice‐chair Updates Depression screening and follow‐up decisions for 2019 Update on 2019 quality pool amount Planning for 2020 measure set

New ways of looking at data trends Finalize 2020 HPQMC recommendations

Finalize 2020 work plan

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 2

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Review November Minutes

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Vice‐chair election

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Health Plan Quality Metrics Committee Update

Dec 13, 2018 Agenda  Presentation: Clinical Quality Metrics Registry  Discussion: Measure crosswalk to priorities, and measure gap assessment  Discussion: Planning for OHPB retreat in January 2019 Next meeting: Jan 10, 2019

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

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Developmental Measures Updates

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Obesity Measure Workgroup Update

Current recommendation under review: A two‐part measure to address child and adult obesity (Ages 3 and up)

  • Component 1, Investments in multisector interventions

– Clinical interventions (treatment) and multisector interventions (prevention) – community policy, systems, and environmental change strategies

  • Component 2, Document BMI and Referral to Intervention; follow up on referral

– Reporting BMI change – EHR‐based 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)

December 2018 Update

  • Technical work group for Component 1 met in December. Began drafting guidelines

for multisector interventions and how to incentivize as a measure.

  • Technical work group for Component 2 will begin meeting in January 2019.
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Health Equity Measurement Workgroup Update

November Discussion: – Continuing to set the groundwork for future metric development. – Presentation on REALD and how it can be used for more granular measure disparity study – Overview of 2017 CCO incentive measures and available race/ethnicity data – Started the discussion on exploring qualitative measures – Discussion of SDOH measure development and intersection with Health Equity Measurement Next Meeting: December 18, 2018 ‐ Discussion: Readiness for measure recommendation in February ‐ Finalize statement of purpose

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

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Public testimony

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Significant Specification Changes by Measure Steward ‐ Longer Term Considerations

  • Precedent of rebasing when significant change to claims‐based measures
  • EHR  options as outlined on next slide (Committee to decide if longer‐term

decision, or immediate situation only)

  • HEDIS measure rebase using most recent specifications (is precedent)

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Depression Screening Measure – Immediate Decisions for 2019

  • Summary of changes
  • Measure steward changed measure such that a PHQ‐2 followed by a PHQ‐9 no

longer counts as follow up (see packet for 2019 specifications, PHQ‐2, and PHQ‐9)

  • Significant concerns raised by TAG and at public testimony at November Metrics

& Scoring Committee meeting,

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Depression Screening Measure – Immediate Decisions for 2019

  • Immediate decision needed for 2019. Options include:
  • A. No change
  • B. Keep in 2019 measure set, but reduce benchmark
  • C. Keep in 2019 measure set, but make reporting only for single year (option to

include as requirement to receive 100% of quality pool)

  • D. Suspend completely for 2019

**Keep but ‘rebase’ 2018 using updated specifications not included as an

  • ption due to significant technical issues in recalculating EHR measures using

updated specifications

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Update on 2019 Quality Pool Amount

(see ‘2019 Quality Pool Amt’ document in packet)

Chelsea Guest, Manager, OHA Actuarial Services

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CCO metrics performance through a new lens

Image source: https://www.digitaltrends.com/cool‐tech/best‐telescopes/

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Reporting typically focuses on:

Current‐year performance Individual CCOs Furthermore, benchmark sources vary from measure‐to‐measure.

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The charts show CCO performance

As a whole Over time Compared against a standard benchmark

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Still not a comprehensive list!

A weak telescope, if you will.

  • Outpatient utilization
  • Any dental service
  • Access to dental service (CAHPS)
  • Health status (CAHPS)
  • Diabetes care: Hba1c testing
  • ED utilization among members with mental

illness

  • Early elective delivery
  • Follow‐up after ED visit for mental illness
  • Low birth weight
  • Oral evaluation for adults with diabetes
  • Potentially preventable hospital admissions:
  • Diabetes
  • COPD or asthma in older adults
  • Congestive heart failure
  • Asthma in younger adults
  • Topical fluoride varnish
  • Weight assessment, nutrition, and activity

counseling

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Moving toward interactive visuals

Your input is valued

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Moving toward interactive visuals

Your input is valued

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Time for a break

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Finalize 2020 HPQMC Recommendations (to be presented in January)

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  • 1. Confirm move from food insecurity screening measure

development, to broader social determinants of health

  • 2. Decisions on health aspects of kindergarten

readiness proposal and next steps

  • 3. Other areas identified from October meeting
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Measure Development Direction

  • At last meeting, heard rational for requesting that

HPQMC prioritize developmental work on broader social determinants of health (which includes food insecurity), versus limiting to food insecurity

  • Supported by OPCA, Food Bank of Oregon, and

OHA

  • Confirm Metrics & Scoring will take this to the

HPQMC in January

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HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP: SUMMARY OF FINAL RECOMMENDATIONS TO THE METRICS AND SCORING COMMITTEE

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Why a Measurement Strategy

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The workgroup proposes a multi-year measurement strategy that aims to drive health system behavior change and investments that contribute to improved kindergarten readiness and cross-sector collaboration.

  • Kindergarten readiness is complex and the domains are interrelated. There is no one

measure that captures all of the health aspects of kindergarten readiness.

  • The proposal builds on the existing CCO incentive metrics focused on children

prenatal through age five.

  • The proposal balances the workgroup’s long-term vision for transformative work on

kindergarten readiness with current momentum and sense of urgency.

  • It includes metrics that are feasible to implement within the next few years, and drives

toward the development of future metrics necessary for progress toward kindergarten readiness.

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Preventive dental visits for children 1-5 years old Well-child visits for children 3-6 years

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CCO-level attestation metric focused on social- emotional health Follow-up to developmental screening (Future) Child-level metric focused on social- emotional health

Health system behavior change, investments, and cross- sector efforts that contribute to improved kindergarten readiness

Health Aspects of Kindergarten Readiness Measurement Strategy Proposal

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Health system behavior change, investments, and cross- sector efforts that contribute to improved kindergarten readiness

Health Aspects of Kindergarten Readiness Measurement Strategy Proposal

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Implementation Recommendations

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There are multiple ways that the Metrics and Scoring Committee can choose to implement the proposed measurement strategy over the next few years. Below are the implementation recommendations preferred by the workgroup: 1) Adopt two metrics now for the 2020 CCO incentive measure set:

  • Well-child visits for children 3-6 years old
  • Preventive dental visits for children 1-5 years old (the Committee can choose to

implement as a standalone metric, or combine with the current dental sealants metric for a more comprehensive children’s oral health metric) 2) Adopt a CCO-level attestation metric focused on children’s social-emotional health once specifications are finalized (i.e., for the 2021 or 2022 CCO incentive measure set). 3) Replace the existing developmental screening metric with a new follow-up to developmental screening metric in 2022 or 2023.

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Implementation Recommendations

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In order to achieve its intended impact and realize its transformative potential, the workgroup strongly believes that this proposal must be implemented as a package.

  • The workgroup’s vision of transformative action and results requires a focus on physical, oral,

developmental and social-emotional health, in combination. Ensuring the components of the strategy remain connected within the CCO Quality Incentive Program will in turn drive CCOs to bridge silos and initiate new ways of collaborating.

  • Some workgroup members felt that a single, bundled measure encompassing physical, oral,

developmental, and social-emotional health would be the most effective tool to drive towards health system behavior change and investments, while others felt there were additional opportunities to achieve the same ends.

  • The workgroup discussed two levers that the Metrics and Scoring Committee could utilize to keep the

focus on all of the components of the measurement strategy together: 1) Having a ‘bundled’ kindergarten readiness challenge pool requiring that a CCO meet each of the components of the measurement strategy to receive challenge pool dollars. 2) Including some or all of the measurement strategy components as a requirement for a CCO to earn 100% of the quality pool dollars for which it is eligible.

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Next Steps Requested of the Metrics and Scoring Committee

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  • Implement the metrics included in our proposal
  • Endorse additional needed measurement work for the

CCO-level attestation metric on social-emotional health and follow-up to developmental screening metric

  • Carry recommendations to the Health Plan Quality Metrics

Committee

  • Utilize levers to keep focus on the entire proposal as a

package

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Optional Next Steps for HPQMC presentation

(assumes Committee endorsement of HAKR package)

At January HPQMC Meeting

  • Summarize package proposal / plan in entirety (previous slides / HAKR report)
  • HPQ2020 (no action needed from HPQMC)

Implementation Year HPQMC – Info Only HPQMC ‐ Endorsement Needed 2020

  • Add preventive dental visits to CCO

measure set

  • Add well‐visit for 3‐6‐year‐olds to

CCO measure set 2021+

  • Plan to switch developmental

screening to follow‐up to developmental screening

  • Development of social‐emotional

screening CCO‐level attestation measure

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Additional Recommendations for HPQMC?

  • Other areas identified from October meeting

– Suicide – HPV – Flu immunizations – Substance use disorders

  • Others?
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Updated Committee Workplan

(see workplan in packet document in packet)

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Future Meeting Locations

  • January 2019: Wilsonville
  • 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)
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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
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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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