Metrics & Scoring Committee December 16, 2016 Consent Agenda - - PowerPoint PPT Presentation

Metrics & Scoring Committee

December 16, 2016

Consent Agenda

 Review agenda  Approve October minutes  Review written updates

2

2017 SBIRT Measure Request

OHA has received a request to remove the claims-based SBIRT measure from the 2017 incentive measure set, given the magnitude of unavoidable coding changes and the lack of time to implement the changes prior to the start of the measurement year. Changes

• Transition to ICD10 coding removed specific screening codes = no

standalone ICD coding option for 2017.

• CPT 99420 has been retired nationally effective Jan 1, 2017.

Replacement codes exist, but there is not yet national consistency in how these codes should be applied to SBIRT. While OHA has selected a replacement code for the specifications, billing systems across the state would have to be reprogrammed immediately.

3

2017 SBIRT Measure Request

OHA agrees with the rationale in the request and recommends the Metrics & Scoring Committee remove SBIRT as an incentive measure for 2017. During 2017, OHA will work with CCOs to operationalize an EHR-based version of the SBIRT measure so it can be reinstated as an incentive measure in the future.

4

Oral Health Access Framework: Report and Recommendations from Oregon’s Medicaid Advisory Committee

5

Presentation overview

• Background and process for developing the Oral

Health Access Framework

• Oral Health Access Framework – definition, model,

monitoring measures

• Initial next steps

6

Oral Health Access Framework: Background and Process

• Dr. Bruce Austin, Dental Director, OHA

Oral health in a changing landscape

2015

• State Health Improvement

Plan (2015-2019)

• OHA Dental Director hired
• Dental sealant metric

adopted as of 2016 2016

• Oral Health in Oregon: OHA

Dental Director report to the legislature (March)

• Restored certain dental

benefits

• Various strategic initiatives

to address access, integration, coordination 2013 Medicaid expansion Affordable Care Act Insurance Marketplaces launch

• Pediatric dental of one 10

Essential Health Benefits

2014

• Strategic Plan for Oral

Health in Oregon (2014- 2020)

• Dental integrated into

CCO model (July)

2013 2017 2015 2014 2016

8

The case for considering access

• Evidence of disparity in utilization

– 27% of OHP adults had a visit in past year (2015) VS 69% Oregonian adults with private dental benefits (2013)

• Anecdotal evidence of access challenges from

members, providers but limited grasp of data

• Recent developments called for agency exploration
• f oral health access

1. Influx of new enrollees in OHP 2. Oral health integration as of July 2014 3. New CMS rules require network adequacy standards for dental providers (pediatric) 9

OHA ask to the MAC: May 2016 Develop a framework for defining and assessing access to oral health for OHP members.

• 1. What are the key factors that influence access to oral health

care for OHP members?

• 2. What key data and information could OHA use to assess

access to oral health services for OHP members? 10

Oral Health Work Group membership

• 3 CCOs
• 3 DCOs
• 3 Providers (2 dentists, 1 hygienist)
• 2 Consumer advocates
• 3 Tribal representatives
• 2 members of general public
• No consumers applied to the work group – staff undertook

separate consumer engagement effort. 11

Summary of consumer feedback

Importance of Dental Coverage

“less stress & worry over how to pay for proper dental care” “first teeth cleaning ever” “every dollar in my family counts”

Access to Care & Barriers

“I need… more availability when trying to make an appointment…” “[more] mobile dental care” “I want information in plain language…” “distance is a huge barrier”

Patient Experience

“OHP always gets the 8am appointment… it’s like they want you to miss that appointment”

Care Coordination & Integration

“oral health affects the rest of my health” “[there’s] not enough time to talk to my doctor about this”

12

Timeline

13

May 25: Request to MAC Summer: Oral Health Work Group meetings (3) Aug-Sept 15: OHP consumer engagement Sept 28: MAC consider Work Group recommendations Sept 21-23: Work Group finalize recommendations MAC memo to OHA: October 2016 Sept 22: Oral Health Work Group presentation to Oregon House Health Committee

Oral Health Access Framework

Matt Sinnott, Willamette Dental Group, OHWG Co‐Chair

OHA/MAC Charge to Work Group

• Standard Definition of Oral Health Access that

provides a common language and understanding of

• ral health access in OHP for OHA and the broader

stakeholder community.

• Oral Health Access Framework Model that lays out

the key factors and influencers that help or hinder

• ral health access in OHP.
• Oral Health Access Monitoring Measures

Dashboard that provides recommended priority measures to monitor key factors of access for OHP members.

15

Standard Definition of Oral Health Access in the Oregon Health Plan

16

Oral health care access is achieved when people* are able to seek out and receive the right care, from the right provider, in the right place, at the right time. Oregon Health Plan members have better oral health care access when: Members, their caregivers, providers and plans understand the importance of oral health and are aware of dental benefits Members have the resources – such as transportation, child care, and accessible care sites – to seek regular oral health preventive services and appropriate treatment as needed Policies and systems are built to facilitate access, by funding oral health benefits, addressing administrative barriers, and incentivizing provider participation Health care providers of all types work together to coordinate oral health care and integrate care into a plan for overall health *Regardless of race, ethnicity, language spoken, culture, gender, age, disability status, income, education, or health.

• Use of services, including

preventive and treatment as needed

• Equity (disparities in use of

services)

• System navigation
• Patient experience
• Quality, patient-centered care (i.e.

right care, right provider, right place, right time)

• Site of care (e.g. community-

based, emergency room)

• Affordability of services
• Missed appointments

UTI LI ZATI ON ( REALI ZED)

• Provider supply & distribution
• Characteristics (e.g. language

spoken, philosophy/ approach to care)

• Participation in Medicaid
• Administrative factors (e.g.

credentialing process)

• Integration of oral, physical and

behavioral health

• Care coordination
• Continuity of care
• Availability of transportation/ child

care

• Characteristics of care site (e.g.

hours, accessibility) AVAI LABI LI TY ( POTENTI AL)

• Dental coverage (children &

adults)

• Stability/ consistency of dental

benefits

• Population health efforts to

reduce disease burden

• Policy/ systems issues, for

example:

• Churn
• Member assignment
• Referral requirements
• Provider incentives
• Budgetary

STRUCTURAL/ SYSTEMS OF CARE

• Oral health/ health needs
• Member empowerment to

seek care

• Oral health literacy
• Access to

transportation/ child care

• Attitudes/ perceptions

(including fear of dentist)

• Income/ assets
• Cultural background, including

preferred language

• Disability status
• Population health
• Social determinants of health

(e.g. housing) OHP MEMBER/POPULATION

OHP ORAL HEALTH CARE ACCESS FRAMEW ORK MODEL Access Oral Health Outcom es

Personal/ Environm ental Factors Potential/ Realized Access Factors

17

• 1. Identify indicators
• f access
• 2. Prioritize top three

“Availability” factors and top three “utilization” factors (consider MAC guidance, next slide)

Work Group Co‐chairs & Staff

• 1. Compile discussion
• 2. Crosswalk priority

factors and indicators with oral health care access measures recommended by local/national groups

• 3. Develop draft

measures dashboard 1. Review, discuss and finalize recommended measures of oral health care access to align with priority factors 2. Select and approve 15 recommended measures

Work Group/MAC

Process: recommending oral health access measures

18

Priority factors of access

MAC guidance: Include factors that ‐ (1) Support the Triple Aim: importance

• f care coordination and patient

experience as a critical components

• f oral health care access in

Medicaid (2) Promote health equity and access for vulnerable and underserved populations within OHP (including people with intellectual and physical disabilities, racial and ethnic minorities, pregnant women, children with special health care needs, and the aging)

19

Availability

• 1. Care Coordination
• 2. Coordination with

mental and physical health (Integration)

• 3. Distribution of

Providers Utilization

• 1. Patient-centered care
• 2. Quality of Services
• 3. Patient experience

ACCESS INDICATOR MEASURE DATA SOURCE MEASURE STEWARD ENDORSED (OREGON) MEASURE TIER Taken from key factors

• f access in

Framework model Measure drawn from existing recommended state/national measures (environmental scan) Identified source for access to data Source for measure specs, etc. Recommended for use by existing OR group (e.g. Dental Quality Metrics WG) Ranked according to ease of implement ation*

20

*Tier 1 measures have the fewest challenges to adoption for monitoring. These measures have been endorsed by an Oregon group and have existing specifications for immediate use by OHA *Tier 2 measures have more challenges to adoption for monitoring. These measures either have no current data source, are not endorsed by an Oregon group, do not have existing specifications for immediate use by OHA, or all

• f the above.

Oral Health Access Monitoring Measures Dashboard

21

ACCESS INDICATOR MEASURE TIER

Care Coordination

Coordination of emergency department visits and dental care Percentage of all enrolled who were seen in the ER for caries‐related reasons within the reporting year and visited a dentist following the ED visit 1 Coordination for patients with chronic

• ral health disease

Percentage of all enrolled/enrolled adults treated for periodontitis who accessed dental services (received at least one dental service) who received comprehensive oral evaluation OR periodic oral evaluation OR comprehensive periodontal examination at least once within the reporting year 2

Oral Health Integration (with behavioral and physical health care)

Coordination of screenings for foster care kids Mental, physical and dental health assessments within 60 days for children in DHS custody 1 Patients with chronic disease (e.g. diabetes) who accessed dental care Percentage of all enrolled adults identified as people with diabetes who accessed dental care (received at least one service) within the reporting year 2 Primary care providers offering oral health services % or # primary care providers providing oral health assessment to patients, as seen through use of D0191 oral health assessment. 2

Provider Distribution

Provider‐to‐population ratios Ratio of OHP licensed dental providers to OHP members, reported by region. Provider types to include the following: Dentists Dental Hygienists (reported by types of hygienist, including EPDH, non‐EPDH) 2

Recommended Monitoring Measures: Availability

22

ACCESS INDICATOR MEASURE TIER

Patient‐Centered Care

Linguistically and culturally appropriate care Number of OHP oral health care providers who completed cultural competency training as reported by the Oregon Board of Dentistry 2 Patient involvement in care How often did the dentists or dental staff explain what they were doing while treating you? (Q12 Dental CAHPS) 2 How often did your regular dentist explain things in a way that was easy to understand? (Q6 Dental CAHPS)

2

Quality of Services

Proportion of population receiving services Number & percent of EVER/Number & percent of CONTINUOUSLY enrolled members receiving at least 1 preventive dental care service during the measurement year 1 Individuals with at least 90 continuous days of enrollment who received at least one diagnostic dental service by or under the supervision of a dentist 2 Percentage of all enrolled members who received a treatment service within the reporting year. 2

Patient Experience

Wait times for appointments If you needed to see a dentist right away because of a dental emergency in the last 12 months, did you get to see a dentist as soon as you wanted? 1 Customer services experience Using any number from 0 to 10, where 0 is extremely difficult and 10 is extremely easy, what number would you use to rate how easy it was for you to find a dentist? 2 Distance to travel to provider Compliance with forthcoming Time & Distance standard: (e.g. minutes/miles standards for urban, rural communities) to pediatric dental providers 2

Recommended Monitoring Measures: Utilization

Recommendations for implementation

• Develop a comprehensive strategy to

implement the Oral Health Access Framework

• Designated responsibility and timelines
• Communication to key groups
• Maintenance of the dashboard and

recommendations over time

• Ongoing consumer engagement

23

Oral Health Access Framework: Initial Next Steps

• Dr. Bruce Austin, Dental Director, OHA

Oral Health Access – Initial next steps

• Dental Director to lead cross‐agency efforts to enhance OHA
• ral health access monitoring strategies and interventions

25

• Initial steps to incorporate MAC recommendations:

– 2017 OHP Dental Metrics Report to incorporate readily available data points – Future CAHPS surveys to include additional dental questions

• Dentist/staff explaining care to patient
• Access to specialists
• Ease at finding a dentist
• Engage dental providers to identify administrative

barriers/opportunities

• Support Metrics & Scoring Committee discussions of future
• ral health integration metrics

26

Oral Health Access – Initial next steps

Metrics and Scoring Committee December 16, 2016

Sara Love, ND Alyssa Franzen, DMD

CCO Oregon

• Non-profit membership association

– Current members include:

• 13 CCOs
• 5 DCOs
• Hospital and Health Systems
• Professional Associations
• FQHCs

28

CCO Oregon

• Primary work is via a variety of

workgroups focused on subjects related to coordinated care in Oregon

• Strive for consensus based work which is

vetted through the workgroups and additional committees that approve the work

• Work products are voluntary agreements

29

Dental Metrics

• Throughout 2015, the Dental Workgroup

focused on the creation of a bank of metrics related to oral health.

• Primary goal was administrative

simplification in service level agreements between CCOs and DCOs

• Metrics across 4 domains: Access,

Process, Experience, Outcome

30

Process

• Started early 2015 with 140+ metrics related

to oral health from a variety of sources including:

– NCQA/HEDIS – Health Resources & Services Administration – CMS – National Quality Forum – CA Healthy Families Program and Oregon Health Authority – Dental Quality Alliance – Healthy People 2020

31

Process

• Rated each metric on a scale 1-5 (5

highest) for both relevance and feasibility

• For a metric to advance had to rate high

by all members for relevance and feasibility

32

Core vs a la carte set

• Core set: limited set of uniform measures

which provide value to a CCO with regard to their dental service delivery

• A la carte set: additional measures that

CCOs can select from that can provide more targeted ability for a CCO to focus

• n an area of importance (CHIP plans,

etc)

33

CCO Alignment efforts

• Special consideration on measures that

align with current CCO metrics for example:

– Pregnant women – Emergency Department utilization – Diabetes care – Tobacco cessation

34

Initial Outcomes

• Presented to TAG in March
• Presented to Medicaid Advisory

Committee-Oral Health Workgroup

– Some metrics chosen for the Oral Health Access Monitoring Measures Dashboard

35

Implementation

• CCO – DCO structure overview
• CCOs have varying levels of oral health

expertise or engagement

• Oral health integration

– What is it? – How do you do it? – What does success look like?

36

Opportunities

• Provides CCOs with set of measures to

transparently measure oral health performance in collaboration with DCO and dental partners

• Provides data consistency while

supporting individual CCO prioritization

37

Challenges

• Challenges to implementation

– Lack of benchmarks

• No diagnostic codes  process measures
• Lack of available data
• Leaves improvement target as option

– Provider culture

• Dental providers still developing culture of metrics

based performance

38

Opportunities

• ral health incentive metrics
• Can we use incentive metrics to drive oral

health integration awareness and importance?

• Need to closely evaluate and understand

sealant metric specifications as we move into years 3,4 and beyond

39

Questions

• For more information www.ccooregon.org
• Contact info: Sara@ccooregon.org

40

41

Public testimony

42

Equity Measure (continued)

43

Equity Measure: Proposal

44

• One measure would be selected for all CCOs (“core”); each CCO

would select a second measure based on local priorities (“menu”)

• CCOs would select at least two specific populations experiencing

disparities on the selected measures to focus on.

• For these measures, instead of “meeting” the measure being

determined by whether or not all members met the benchmark or improvement target, CCOs would only “meet” the measure if the selected populations met the benchmark or custom improvement target.

Equity Measure: CCO Feedback

45

Measures chosen most frequently:

• Developmental screening
• Adolescent well care visits
• Effective contraceptive use
• Colorectal cancer screening
• ED utilization

Populations chosen most frequently:

• Age
• Race/ethnicity
• Geography (rural populations)
• Disabilities and/or mental health / SPMI diagnoses

Equity Measure: CCO Feedback

46

When asked whether CCOs should be required to pick at least one racial / ethnic populations as one of their two populations, the answer was a resounding no, due to the variability among CCOs’ populations. When asked whether community involvement occurred to inform the selection:

• Few CCOs engaged in robust community engagement this time
• Several referenced health equity consultations with Ignatius Bau

When asked what the process might look like next year:

• Working with Community Advisory Councils, local public health

agencies, and/or community health centers

• Working with members of the community with ties to selected

populations (e.g., culturally specific groups / orgs)

Equity Measure: CCO Feedback

47

• Unsure whether it makes sense to have a core metric
• Lack of good demographic data is an obstacle
• Disparities used for equity measure should pass a test of statistical

significance

• Improvement targets should be customized for each population
• Consider measures where additional data collection or reporting

might be needed

Equity Measure: Retreat

48

General support for dropping the concept of a core and menu measure set overall, and incorporating the equity measure, which would allow CCOs some flexibility.  Is the Committee ready to make a decision about adding the equity measure to the 2018 measure set?  What are the parameters for the equity measure?

Next Meeting: January 20, 2017

49