Metrics & Scoring Committee January 20, 2017 Consent Agenda - - PowerPoint PPT Presentation

Metrics & Scoring Committee

January 20, 2017

Consent Agenda

 Review agenda  Approve December minutes  PCPCH final decision

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Review workplan for 2018 measure selection

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Public testimony

Equity Measure (continued)

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December Recap

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• Committee reviewed CCO feedback on which populations and

measures they might select

– Measures chosen most frequently include developmental screening, adolescent well care visits, effective contraceptive use, colorectal cancer screening, and emergency department utilization. – Populations chosen most frequently include age, race/ethnicity, geography, disability and/or mental health / severe and persistent mental illness diagnoses.

• Committee discussed

– Whether CCOs should be required to pick a racial/ethnic population – Whether age met the Committee’s intent for the measure – Whether white populations met the Committee’s intent for the measure – Whether a reporting only / process measure was possible

• Request for staff proposal

Staff Recommendation

OHA recommends that the Committee only adopt one equity measure for 2018 (as there are multiple topics also under discussion for potential 2018 measures). Based on previous Committee discussion, workgroup discussion over the past year, measure feasibility, and recent performance, OHA recommends the Committee adopt one of two options.

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Staff Recommendation: Option 1

Select ED utilization as the equity measure for all CCOs. Each CCO must chose two populations experiencing disparities to focus on. ED utilization is high impact, has sufficiently large denominator for all CCOs, and shows disparities across multiple populations (including race/ethnicity, gender, language, urban/rural, people with SPMI, etc.)

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Benefits Limitations

 Sufficient denominator size for all CCOs  Utilizes existing data and reporting / can be monitored throughout the year  Quality improvement efforts likely multi- faceted (e.g., access, avoidable ED, care coordination)  Simple to explain  While Oregon overall is doing well on ED utilization, certain populations are being left behind.  Oregon already doing well on ED utilization (approaching 90th percentile for Medicaid population as a whole), so focus may be better put elsewhere.

Option 1a: Select population for all CCOs

(OHA top recommendation)

ED utilization for individuals experiencing SPMI

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ED utilization among members with SPMI compared with members

• verall in each CCO (mid-2016)

39 39 46 53 41 48 50 45 31 41 33 47 60 39 45 64 95 97 106 142 105 117 109 109 83 104 84 113 120 89 122 155

Option 1b: Require one of two populations to be racial / ethnic group

• Disparities by race/ethnicity are not as great as SPMI for ED

utilization

• Decision needed whether CCOs can select white population.

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Staff Recommendation: Option 2

Select a specific population for all CCOs CCOs can select any of the incentive measures for which there is available data and sufficient denominator size (n>30) for which this population is experiencing a disparity.

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Benefits Limitations

 Sufficient denominator size for all CCOs  Historically disadvantaged population  Multiple measures to select from  Utilizes existing data  Focus on one population could result in significant improvements across multiple areas  Simple to explain  Focus on one population but multiple measures could result in confusion, or lack

• f coordination in efforts to reach

population, particularly in areas where CCOs share geography.  CCOs will need to select measure and write proposal.

Option 2

Option 2a: select members with disability as the specific population Option 2b: select members with SPMI as the specific population

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Additional benefits Additional limitations  Eligibility codes apply to both children and adults, further increasing the number of applicable measures  Reporting relies on Medicaid eligibility codes; self-reporting is not included, resulting in an undercount of all members with disability. Additional benefits Additional limitations  SPMI diagnosis apples to adults only, limiting the number of measures from which CCOs could choose.

Option 2 continued

Staff does not recommend selecting a racial/ethnic group as the specific population for the equity measure.

• Denominators are too small for many group / measures.
• While all CCOs have at least one measure reportable by each

population (with the exception of Hawaiian / Pacific Islander), the measure for which the CCO might have sufficient population (n>30) may not be an area where that population is experiencing a disparity.

• This approach would back CCOs into working on a measure for a

population that may not show disparity, or where greater disparities exist among other populations.

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Discussion

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PATIENT EXPERIENCE MEASURES

What is patient experience?

The full range of patients’ interactions with the health care system, from scheduling appointments to interactions with their providers, to the course of treatment, including whether these interactions meet patient needs and goals – FamiliesUSA Quality Measurement Brief The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care – The Beryl Institute The range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities. As an intergral component of health care quality, patient experience includes several aspects

• f health care delivery that patients value highly when they seek and receive

care, such as getting timely appointments, easy access to information, and good communication with providers - AHRQ

Why include patient experience?

• Key element of HHS National Quality Strategy; CMS is mandated to include

patient experience in programs, including ACOs, hospital value-based purchasing, etc…and CMS Access Monitoring Plan requires CAHPS data.

• Research indicates that better patient care experiences are associated with

higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety, and lower utilization.

• Measuring patient experience complements other quality measures by

generating information about aspects of care for which patients are the best / only source.

• Patient experience measures provide rigorous, validated alternatives to

subjective reviews (e.g., ratemydoc, Yelp)

Common concerns

• Patient feedback is not credible because patients lack formal

medical training and “satisfaction” = “happiness”, which is highly subjective to factors unrelated to care provided.

• Patient experience measures could be confounded by factors that

are not directly associated with quality processes.

• Patient experience measures could reflect fulfillment of patients’

immediate desires, regardless of care experience / benefit, which reduces the validity of their perspective.

How to measure patient experience?

• CAHPS surveys are widely regarded as the national standard for

collecting and reporting patient experience information.

• Existing CAHPS surveys for health plans, clinicians, dental, home

health care, hospice, hospitals, surgical care, and more. CAHPS is under constant research to improve it and new CAHPS surveys for ACOs, emergency departments and other settings are under development.

• CAHPS survey questions often combined into composite measures:

– Summarizes large amounts of information and makes it easier for people to review and compare (fewer points of comparison) – Recommended as primary reporting strategy

How do we decide which CAHPS measures to use?

Can compare state performance to national benchmarks Can compare performance across health plans or for specific populations to identify gaps Can use CAHPS results to develop a priority matrix to identify gaps and strengths, based on correlation between the Rating of Health Care measure and other composites.

0.4 0.8 0.0 A1 A2

S1

S2 H C1 C4 C3 C2 A4 A3 High correlation Low priority High correlation High priority

Low correlation High priority Low correlation Low priority Correlation with Health Care Rating

Current CAHPS measures

Access to Care

(Members received appointments and care when they needed them)

Satisfaction with Care

(Health plan customer service treated member with courtesy and respect and provided needed information)

Current CAHPS measures: Access to Care

Q4: Whether the respondent got urgent care for illness / injury as soon as they needed Q6: Whether the respondent got non-urgent appointments as soon as they needed Adult Child

Statewide Excellent / Very Good / Good Health Status Fair / Poor Health Status Male Female CCO Range National Comparison Q4 84% 87% 79% 87% 83% 75 – 91% 84% Q6 77% 77% 78% 76% 78% 72 – 84% 78% Average 80.7% 82.2% 78.3% 81.6% 80.5% 75.1 – 85.1% 80% Statewide Excellent / Very Good / Good Health Status Fair / Poor Health Status Chronic Conditions No Chronic Conditions CCO Range National Comparison Q4 92% 93% 83% 93% 91% 86 – 97% 91% Q6 84% 85% 72% 84% 85% 80 – 93% 88% Average 88.1% 89.1% 77.4% 88.5% 87.9% 83.9 – 94.8% 90%

Current CAHPS measures: Satisfaction with Care

Q31 / 50: How often the health plan’s customer service gave necessary information / help Q32 / 51: How often the health plan’s customer service was courteous and respectful Adult Child

Statewide Excellent / Very Good / Good Health Status Fair / Poor Health Status Male Female CCO Range National Comparison Q31 76% 77% 75% 78% 75% 72 – 87% 80% Q32 91% 93% 90% 91% 92% 87 – 97% 93% Average 83.6% 84.4% 82.8% 84.6% 83.4% 77.8 – 89.6% 87% Statewide Excellent / Very Good / Good Health Status Fair / Poor Health Status Chronic Conditions No Chronic Conditions CCO Range National Comparison Q50 79% 79% 79% 77% 80% 68 – 85% 82% Q51 91% 91% 91% 90% 92% 84 – 97% 94% Average 85.3% 85.1% 85.0% 83.6% 85.9% 75.6 – 90.5% 88%

Non-CAHPS patient experience measures?

Limited options

• NQF 1821 L2 – Patients receiving language services

supported by qualified language services providers

• NQF 2483 – Gains in Patient Activation (PAM) score at

12 months

• NQF 0726 – Patient experience of psychiatric care as

measured by the Inpatient Consumer Survey

Discussion

Next Meeting: February 17, 2017