Metrics & Scoring Committee May 17, 2019 Todays Agenda - - PowerPoint PPT Presentation

Metrics & Scoring Committee

May 17, 2019

Today’s Agenda

Welcome, review previous minutes, general updates Individual measure review and assessment

 Assessments for kids in DHS custody  Depression screening and follow-up  Colorectal cancer screening  Diabetes: HbA1c poor control  Controlling hypertension  Effective contraceptive use  CAHPS access to care  Cigarette smoking prevalence

Review findings from stakeholder survey

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

Review April Minutes

3

4

HPQMC Updates

May 9 meeting highlights

• Presentation on State Health Improvement Priorities
• Presentation and discussion on inclusion of a Health Equity Measure in the

2020 measure menu set

• Measure purpose: Meaningful access to health care services through the

provision of certified and qualified interpreters.

• The committee voted to not include this measure in the 2020 measure menu

set.

• No legislative updates
• June 13 meeting: Welcome new members to the committee

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

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Developmental Measures

Health Aspects of Kindergarten Readiness

• Social emotional health measure development

Social Determinants of Health Health Equity Measure

• Refined measure presented to HPQMC on 9 May

Obesity

• TAG providing feedback on revised specifications on 23 May

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Committee Appointments

• Under review by OHA leadership
• Appointments begin August 2019

Public testimony

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Individual Measure Review

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Measure: Assessments for Children in DHS Custody - Committee Decision Recap

Component Current OHA CCO specs DHS OAR 413-015-0465 age timeline age timeline Physical health assessment 0-17 60 days 0-17 30 days Dental health assessment 1-17 60 days 1-17 30 days Mental health assessment 4-17 60 days 3-17 60 days

• Current metric does not align with DHS policy or American

Academy of Pediatrics (AAP) recommendations

• AAP - see page 22: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-

america/Documents/Ch2_PP_Primary.pdf#Page=12

• Child Welfare Policy: OAR 413-015-0465
• Also note House Bill 3372 of 2017 requires CCOs to perform initial health assessments in accordance with the

metric established by the Metrics and Scoring Committee.

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Measure: Assessments for Children in DHS Custody

• Overview: Percentage of children and adolescents who received timely mental, physical, and

dental health assessments after entering DHS custody

• Data Source: MMIS/DSSURS and ORKIDS
• Equation:

=

Depending upon age at CCO notification, identified children/adolescents must receive each of the components below within the specified timeframes:

Component Age Timeline Physical health assessment 0-17 30 days Dental health assessment 1-17 30 days Mental health assessment 3-17 60 days

Identified children/adolescents 0 – 17 years of age as of the first date of DHS/OHA notification and who remained in custody for at least 60 days.

• Include only those about whom DHS/OHA notified the CCO in the weekly file

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Measure: Assessments for Children in DHS Custody

• Continuous Enrollment Criteria:
• All children continuously enrolled with the notified CCO (with CCOA coverage) from the date of CCO

notification through 60 days after with no gaps in coverage.

• Children with delayed start of enrollment to the notified CCO for up to 7 days are only included if they are

also numerator compliant (the CCO would receive credit on the metric).

• Children with a delayed enrollment and who did NOT complete all required assessments are excluded.
• NB:
• To allow time for follow-up, children are included in the denominator if the CCO is

notified of enrollment from November 1 of the year prior to the measurement year, to October 31 of the measurement year.

• There are numerous exclusions from the measure, including:
• Children on runaway status
• The CCO does not receive notification from OHA that the child is in DHS custody (even if DHS notifies

the CCO)

• The CCO does not receive timely notification from OHA

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Statewide median days to completed assessment (preliminary data)* Custody notification period Number of Children Physical Health - Days Dental Health - Days Mental Health - Days 11/1/2017 - 10/30/2018 (2018 measurement year) 1,662

• 3

24 16 5/1/2017 - 4/30/2018** 1,884 28 16 4/1/2017 - 1/31/2018 1,426 28 15

Measure: Assessments for Children in DHS Custody preliminary data

*Only included case that completed all required assessments using CCO specs ** Starting in 2018Q2 reporting period, a full year intake period is used (instead of 10 months)

Measure: Assessments for Children in DHS Custody preliminary data

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Rate Comparison – 2018 versus 2020 Specifications (using AAP/DHS policy)

Custody notification period Number of Children 2018 Specifications 2020 Specifications Physical Only Dental Only MH Only All required Physical Only Dental Only MH Only All required 11/1/2017 - 10/30/2018 (2018 measurement year) 1,932 95.3% 88.4% 93.6% 86.0% 84.6% 52.2% 91.4% 54.3% 5/1/2017 - 4/30/2018** 2,230 94.6% 88.0% 92.4% 84.5% 83.4% 51.0% 89.5% 52.5% 4/1/2017 - 1/31/2018 1,734 94.4% 85.9% 91.9% 82.2% 82.9% 48.3% 89.1% 49.4%

Measure: Assessments for Children in DHS Custody preliminary data

** Starting in 2018Q2 reporting period, a full year intake period is used (instead of 10-months)

Work Group of DHS and CCO Representatives Meeting Monthly Since November, 2018

• Discussed work flows on placement and information
• Talked about Shelter Orders, Placement, Federal

Review Specialists and how Medical Assistant Specialists do CCO enrollment

• Some discussion around patient portals and case

management tools and dummy placement codes

• Discussed barriers and challenges
• DHS automatic enrollment into CCO-A—Shelly Watts

New process idea….What Staff Can “Control”

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Proposed Plan- Operationalize the Work Plan

• Start 30-day clock on Medicaid Notification to CCO Enrollment (as now)
• Use 834 forms or other inter-agency aids to have informal communication between groups
• Medical Assistant Specialist will be contact since case worker usually out
• Roles and responsibilities of each person is operationally documented
• CCOs have identified contacts who form relationship with each Medical Assistant Specialist
• Communication system becomes independent from paperwork entry or formal metric
• Status of each newly enrolled child is updated as it changes until appointments fulfilled-CCO

notify back to DHS date when completed if possible

• Sign off by top leadership to support this plan so there is agency commitment
• Further process changes will be necessary and potential tools for interagency secure

communication may be needed (exploring for future)

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Metric Officially Calculated

• Incentive metric is officially aligned with DHS as much as operationally possible because of

the control of information exchange related to the medical, oral and mental health focus

• The coordination “on the ground” is managed by person-to-person contact and networking
• More support will be requested for strengthening these “people networks” from

Transformation Center and Innovator Agents who can be very helpful with connecting people to Field Offices

• The 834 Enrollment Forms will give 1-2 week head start and more information exchange with

DHS partners on the ground

• Official metric start time will remain notification
• Group will continue to meet regarding vocabulary and status for foster children “trial

reunification” and other terms

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Measure: Depression Screening and Follow-up

• Overview: Percentage of adult patients (ages 18 and older) who had appropriate screening and

follow-up planning for major depression

• Data Source: EHR; electronic Clinical Quality Measure (eCQM)
• Equation:

=

Patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period.

• Eligible encounters are identified through the Depression Screening Encounter Codes

Grouping Value Set (2.16.840.1.113883.3.600.1916). Patients screened for depression on the date of the encounter, using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screen

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Measure: Depression Screening and Follow-up

• Continuous Enrollment Criteria: None. The “eligible as of the last date of the reporting

period” rule may be used to identify beneficiaries to be included in the measure.

• NB:
• Beginning in 2019, the measure steward, CMS, no longer counts numerator credit for a

PHQ-2 screen followed by a PHQ-9 screen (where PHQ-9 is treated as follow-up to a positive PHQ-2).

• Beginning in 2020 (CMS2v9), the measure steward, CMS, will allow the screening to be

administered up to 14 days before the date of the encounter, for example, through a patient portal in advance of the appointment.

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Measure: Depression Screening and Follow-up

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Measure: Colorectal Cancer Screening

• Overview: Percent of adult members (ages 50-75) who had appropriate screening for colorectal
• cancer. (HEDIS measure)
• Data Source:
• Denominator: Administrative data (MMIS/DSSURS)
• Numerator: MMIS/DSSURS, medical records (hybrid: chart review + claims)
• Equation:

=

Medicaid enrollees age 51-75 years as of December 31st of the measurement

• year. OHA provides CCOs with the sampling frame for the chart review.

Unique number of individuals receiving at least one of the screening types listed in the technical specifications either during the measurement year or in years prior to the measurement year

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Measure: Colorectal Cancer Screening

• Continuous Enrollment Criteria: The measurement year and the year prior to the measurement

year with one allowable 45 day gap

• NB:
• OHA identifies members from administrative data and provide CCOs with a random

sample list for the chart review (411/CCO)

• The specifications contain details on chart review criteria, including whether a result

must be present, the number of samples, etc.

• HEDIS 2020 specifications are not yet available, but it is likely that changes from 2018 to

2019 will continue (and will be taken into account in OHA samples):

• New exclusion for those ages 66 and older with advanced illness and frailty (using advanced illness

value set and dementia medication list)

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Measure: Colorectal Cancer Screening

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Measure: Diabetes - HbA1c poor control

• Overview: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c ˃

9.0% during the measurement period (a lower score is better).

• Data Source: EHR; electronic Clinical Quality Measure (eCQM)
• Equation:

=

Patients 18-75 years of age with diabetes with a visit during the measurement period (diabetes is identified using the Diabetes Grouping Value Set - 2.16.840.1.113883.3.464.1003.103.12.1001). Patients whose most recent HbA1c level (performed during the measurement period) is >9.0%.

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Measure: Diabetes - HbA1c poor control

• Continuous Enrollment Criteria: None. The “eligible as of the last date of the reporting period” rule

may be used to identify beneficiaries to be included in the measure.

• NB:
• Only patients with a diagnosis of Type 1 or Type 2 diabetes are included in the denominator;

patients with a diagnosis of secondary diabetes due to another condition are not be included.

• Patient is numerator compliant if:
• The most recent HbA1c level >9%;
• The most recent HbA1c result is missing, or,
• If there are no HbA1c tests performed and results documented during the measurement period.
• Exclusions: Patients in hospice. Beginning in 2020 (CMS122v8), the measure steward, NCQA,

added new exclusions for patients aged 66+ who (1) are living long term in an institution for 90+ days or (2) have advanced illness and frailty.

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Measure: Diabetes - HbA1c poor control

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Measure: Controlling hypertension

• Overview: Percentage of adult patients (ages 18–85) with a diagnosis of hypertension (high

blood pressure) whose condition was adequately controlled.

• Data Source: EHR; electronic Clinical Quality Measure (eCQM)
• Equation:

=

Patients 18-85 years of age who had a diagnosis of essential hypertension1 within the first six months of the measurement period or any time prior to the measurement period (Essential hypertension is identified using the Essential Hypertension Grouping Value Set

• 2.16.840.1.113883.3.464.1003.104.12.1011).

Patients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg) during the measurement period.

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Measure: Controlling hypertension

• Continuous Enrollment Criteria: None. The “eligible as of the last date of the reporting

period” rule may be used to identify beneficiaries to be included in the measure.

• NB:
• Numerator notes:
• If no blood pressure is recorded during the measurement period, the patient’s blood

pressure is assumed “not controlled.”

• Remote monitoring:
• For 2019 and earlier, only blood pressure readings performed by a clinician in the provider office

are acceptable for numerator compliance with this measure. Blood pressure readings from the patient’s home (including readings directly from monitoring devices) are not accepted.

• Beginning in 2020 (CMS165v8), readings from a remote monitoring device will count. This does

not include readings reported by or taken by the member.

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Measure: Controlling hypertension

• NB (continued):
• Exclusion notes:
• Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant; patients with a

diagnosis of pregnancy during the measurement period; patients in hospice.

• Beginning in 2020 (CMS165v8), the measure steward, NCQA, added new exclusions for patients aged

66+ who (1) are living long term in an institution for 90+ days or (2) have advanced illness and frailty.

• Threshold of adequate control (HEDIS v CMS eCQM specs):
• HEDIS specs had carved out for members age 60-85 without diabetes a threshold of <150/90; as of

2019 measurement period, HEDIS eliminated that carve-out

• eCQM specs consistently used <140/90 for all adults 18-85 with hypertension, with no carve-out
• Bottom line: As of 2019 measurement period, HEDIS and CMS eCQM specs are back in alignment on

the threshold of adequate control

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Measure: Controlling hypertension

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Measure: Effective Contraceptive Use

• Overview: Percentage of women (ages 15-50) with evidence of one of the most effective or

moderately effective contraceptive methods during the measurement year: IUD, implant, contraception injection, contraceptive pills, sterilization, patch, ring, or diaphragm.

• Data Source: MMIS/DSSURS
• Equation:

=

All women ages 15-50 as of December 31 of the measurement year (subject to exclusions) Women in the denominator with evidence of female sterilization anytime throughout the claims history in OHA’s system, OR one of the following methods of contraception during the measurement year: IUD, implant, contraception injection, contraceptive pills, patch, ring, or diaphragm

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Measure: Effective Contraceptive Use

• Continuous Enrollment Criteria: The measurement year with one allowable 45 day gap
• NB:
• Denominator exclusions for: hysterectomy; Bilateral oophorectomy; Other female

reproductive system removal, destruction, resection related to hysterectomy; Natural menopause; Premature menopause due to survey, radiation, or other factors; Congenital anomalies of female genital organs; Female infertility (exclusion data source: claims in OHA system - to 2002, and additional information provided by CCO)

• Among women in the denominator who were not numerator compliant, women with a

pregnancy claim in the measurement year are excluded

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Measure: Effective Contraceptive Use

• NB (cont):
• The denominator is an overcount of women in need of contraception. Historically, the

Committee has accounted for this in setting the benchmark for the measure (currently at 53.9%).

• There is a CMS measure of effective contraception which was modeled after that in Oregon.

Differences include:

• Age range (Oregon measure is 15-50; CMS is 15-44)
• Approach to pregnancy is treated differently
• CMS reports separate rates for the two tiers of contraception
• Differences in how LARC is captured
• Oregon includes more numerator codes for indirect evidence and surveillance of

effective contraceptive methods

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Measure: Effective Contraceptive Use

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Measure: Effective Contraceptive Use

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Measure: CAHPS, Access to Care

• Overview: Percentage of members who thought they received appointments and care when

they needed them.

• Data Source: Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan

Survey 5.0H, Adult and Child Versions

• Equation:

=

CAHPS Getting Care Quickly Composite, based on two questions:

• Got care right away for illness / injury / condition as soon as you / child needed.
• Got an appointment for routine care as soon as you / child needed.

Those answering ‘always’ or ‘usually’

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Measure: CAHPS, Access to Care

• Continuous Enrollment Criteria: Members must have 6 months experience with Medicaid/OHP

to be eligible for the survey sample.

• NB:
• The survey is fielded in quarter one following the measurement year (members are asked to

about their experiences in the previous year).

• Separate rates are calculated for (a) children and (b) adults. Beginning in the 2018

measurement year, CCOs must achieve both child and adult benchmark or improvement targets for metric credit.

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Measure: CAHPS, Access to Care

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Measure: Cigarette Smoking Prevalence

• Overview: Cigarette smoking among members ages 13+
• Data Source: EHR (home-grown measure)
• Equation:

=

Unique Medicaid members age 13 years or older who had a qualifying visit with the provider during the measurement period and who have their smoking and/or tobacco use status recorded as structured data Patients reporting cigarette use:

• Current every day smoker
• Current some day smoker
• Smoker, current status unknown
• Heavy tobacco smoker
• Light tobacco smoker

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Measure: Cigarette Smoking Prevalence

• Continuous Enrollment Criteria: None. The “eligible as of the last date of the reporting

period” rule may be used to identify beneficiaries to be included in the measure.

• NB:
• In addition to the cigarette smoking prevalence rate, OHA also collects data on the (a)

proportion of members with their tobacco status recorded and (b) the proportion of members who use tobacco (broader than cigarette use).

• Cigarette smoking/ tobacco use status must be recorded during the measurement year
• r the year before.
• The Metrics & Scoring Committee has chosen to set a benchmark for cigarette smoking

prevalence only.

• Starting with the 2019 measurement year, the cessation benefit survey is no longer a

component of the measure.

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Measure: Cigarette Smoking Prevalence

Stakeholder Survey Findings

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Stakeholder Survey

• Online survey fielded from 10 April – 6 May
• Intent to collect feedback from a variety of stakeholders, including coordinated

care organizations (CCOs), providers, community partners, state programs, and

• ther advocates with an interest in the CCO incentive measures
• 288 responses received

Percent Ranking Number 1 (Most Like To See Included)

a

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Ti Time e for a a brea eak

M&S &S F Future A Agendas as

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June 2019

Catchup…begin formal selection of 2020 measure set

July 2019

Finalize 2020 measure set

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

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Retirement Checklist

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Metrics & Scoring Committee’s measure retirement checklist was adopted in June 2015 for the Committee’s use when retiring CCO incentive measures. Not all of these criteria must be met before a measure could be retired. Note retired CCO incentive measures may continue as monitoring measures. No additional opportunity for meaningful performance improvement (“topped out”) Measure no longer adds meaningful value Supporting clinical guidelines or evidence-base have changed Measure has been retired nationally / pending retirement by measure steward Measure cannot be measured

Retirement History

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2015

Follow-up for children prescribed ADHD medication Early elective delivery

2016

Electronic health record adoption

2017

Claims SBIRT

2018

Follow-up after hospitalization for mental illness Satisfaction with care (CAHPS)

2019

Timeliness of Prenatal Care

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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)

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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Quality Pool Distribution

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• Amount earned is based on percentage of payments to that CCO in the year (4.25% in

2018; will be lower in 2019). This is the full quality pool payment (i.e., maximum amount) a CCO can earn.

• To earn their full quality pool payment for 2019, CCOs must:
• Meet or exceed the 0.68 threshold score on the PCPCH enrollment measure; AND,
• Report data for minimum population thresholds as described in OHA reporting guidance for both the

SBIRT and Depression screening and follow-up measures; AND,

• Meet or exceed the benchmark or improvement target on at least 75% of the remaining incentive

measures.

• A CCO does NOT need to meet the benchmark or improvement target on all 19 measures

to earn the full quality pool amount.

Quality Pool Distribution

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• If the above are not met, the CCO earns a smaller proportion of the full quality pool payment for which

it was eligible. Below is an example for 2018:

Quality Pool Distribution Table - 2018 Number of targets met for non-PCPCH measures (achieving benchmark / improvement target, & reporting requirements for EHR measures) Quality Pool Amount if MEET or EXCEED PCPCH Measure Threshold Score of 0.60 Quality Pool Amount if PCPCH Measure Score <0.60 (i.e., do not meet PCPCH measure threshold) at least 12 100% 90% at least 11 80% 70% at least 10 70% 60% at least 8 60% 50% at least 6 50% 40% at least 4 40% 30% at least 3 30% 20% at least 2 20% 10% at least 1 10% 5% 5% No quality pool payment

• Money left over from the quality pool goes to a challenge pool. To earn the challenge pool payments,

CCOs have to meet the benchmark or improvement target on the challenge pool measures (a subset of full measure set).

Measure Selection Criteria – Individual Measures

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Measure Selection Criteria – Set

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