Metrics & Scoring Committee November 16, 2018 HEALTH POLICY - - PowerPoint PPT Presentation

Metrics & Scoring Committee

November 16, 2018

HEALTH POLICY & ANALYTICS Office of Health Analytics

Today’s Agenda

✓Welcome ✓Presentations on developmental measures

✓From Food Insecurity to Addressing Other SDOH: Measure Proposal ✓Update on obesity measure development ✓Final proposal from Health Aspects of Kindergarten Readiness Technical workgroup

✓Review draft HPQMC measure selection criteria

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

2

Review October Minutes

3

3

Health Plan Quality Metrics Committee Update

Met Thursday, November 8 ✓Presentation: Behavioral Heath Measurement (Integrated Behavioral Health Alliance) ✓Workplan 2018-2019 – Adopt Health Priorities for Aligned Measure Menu Set and Finalize measure selection criteria Looking Ahead ✓Work with OHPB and Metrics & Scoring leadership to coordinate workplans and align priorities for metrics (along with PHAB) ✓Continued development of the workplan ✓March 2019 - Finalize Aligned Measure set for 2020 Next regular meeting: December 13

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

4

5

Measure Development Work

• Health Equity Measurement Workgroup

– First meeting on Monday, October 29 – Membership: – Metrics an and Scorin ing Com

• mmit

ittee: Will ill Brake – Health Equity Committee: Carly Hood-Ronick – Health Equity Committee : Michael Anderson-Nathe – Health Equity Committee: Derick Du Vivier, MD. – OHA Office of Equity and Inclusion Director: Leann Johnson – Public Health Advisory Board: Jeff Luck – Public Health Advisory Board: Eli Schwartz – OHA Health Analytics Director: Jon Collins – OHA Medical Director: Dana Hargunani, MD

6

Measure Development Work

October Discussion: – Creating a shared understanding of the purpose of the workgroup and its intended goals – Definitions of Health and Health Equity – Agreement that the workgroup will needs to develop strong recommendations and will take the time needed to do this. Looking Ahead: 1.Review what we are currently measuring; Develop a framework for measurement 2.Based on the measures and other supporting data, identify the levers (measures or systems in place to leverage) for measures and measurement 3.Determine readiness for a measure or measurement strategy recommendation for February. Next Meeting: November 29, 2018 (11am – 1pm) 421 SW Oak St, Portland – Suite 750, OEI Conference Room For more information: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Health-Equity-Measurement-

Workgroup.aspx

Public testimony

7

From Food Insecurity to Addressing Other Social Determinants of Health: Measurement Proposal

Lynn Knox Statewide Health Care Liaison Oregon Food Bank

8

Valerie Stewart, PhD Metrics Manager Oregon Health Authority Carly Hood-Ronick, MPA, MPH Social Determinants of Health Manager Oregon Primary Care Association

Presentation Outline

• History and current opportunity
• Summary of eastern state models for measuring social determinants of

health at the plan level

• Next steps

9

History

• July 2015 – July 2016: TAG began discussions of a potential food insecurity

screening measure following Metrics & Scoring Committee interest, ultimately developing a specification at the provider / clinic level

• November 2017: Metrics & Scoring Committee includes measure of food

insecurity screening in list of 26 measures proposed to HPQMC

• April 2018: Based on Metrics & Scoring Committee recommendation,

HPQMC includes food insecurity as one of its 16 developmental measures and subsequently highlights it as a high priority in terms of further development (crafting a reliable measure at the plan level)

10

Current State

• During this time, there has also been significant movement in the field around

the social determinants of health (including, but not limited to, food insecurity).

11

SDH Domains in Commonly Used National Tools

– Housing & stability – Material Security (includes food security) – Transportation – Income – Employment – Education – Race, Ethnicity, & language – Migrant and/or seasonal farm work – Veteran status – Address/neighborhood – Insurance – Social integration and support – Stress – Optional measures on incarceration, refugee status, safety, and domestic violence

12

PRAPARE ACH Screening Tool

– Housing instability – Food insecurity – Transportation problems – Utility help needs – Interpersonal safety – Financial strain – Employment – Family and community support – Education – Physical activity – Substance use – Mental health – Disabilities

PRAPARE and AHC Cross walk

Education Housing Transportation Food Utilities Domestic violence

Current State (cont)

– Focus on social determinants of health in Oregon’s most recent Medicaid waiver, direction from the Governor to focus on this area, and in policy options to be included in CCO 2.0 – Very recent measurement development around social determinants of health in

• ther states (more in later slides)

14

Opportunity

• Concern that a narrow focus on food insecurity would disrupt work that is already underway

in terms of broader SDOH, and limit what we could achieve with a new incentive measure

• However, given the work around SDOH (which includes food security), there is an
• pportunity to expand the scope of the measure development work from a narrow focus on

food insecurity to a broader focus social determinants of health.

• This would align with work currently happening the field, and broader efforts in our state, and

nationally.

• This shift is supported by the Oregon Food Bank, the Oregon Primary Care Association, and

the Oregon Health Authority.

15

Decision Needed: After hearing our full presentation, does the Metrics & Scoring Committee support shifting this developmental work from food insecurity, specifically, to broader SDOH?

Eastern State Models for Measuring Social Determinants of Health at the Plan Level

16

So what are social determinants of health?

• Conditions in which people are born, grow, live work, and age
• Shaped by money, power, and resources: complex issues that need to be

addressed at multiple levels and sectors

• These social determinants are largely responsible for health disparities and

inequities.

• Examples are: ✔ affordable housing, ✔ economic security,

✔ safe neighborhoods, ✔ access to healthy and adequate foods, and ✔ exposure to environmental toxins or trauma.

17

• O. Solar and A. Irwin, World Health Organization, “A Conceptual Framework for Action on the Social Determinants of Health,”

Social Determinants of Health Discussion Paper 2 (Policy and Practice), 2010, available at http://www.who.int/social_determinants/corner/SDHDP2.pdf.

NQF and CMS Recommendations for SDOH

Community and Healthcare System Linkages

– Acknowledge role of Medicaid in addressing SDOH – Create a comprehensive, accessible and routinely updated list of community resources

Information Sharing and Measurement

– Harmonize tools that assess social determinants of health – Create standards for input and extraction of social needs data from electronic health record – Increase data sharing among different government agencies

18 National Quality Forum, “A Framework for Medicaid Programs to Address Social Determinants of Health: Food Insecurity and Housing Instability,” December

• 2017. Available at http://www.qualityforum.org/Publications/2017/12/Food_Insecurity_and_Housing_Instability_Final_Report.aspx.

Define-Describe Oregon Needs

• Multi-sector focus to create better equity for members
• Approach must support OHA policy, health equity, demonstration waiver,

governor report, quality framework/models in CCO 2.0

• Needs to fit in with existing programs and “resonate” with other activities such as:

✔ Health equity work group ✔ Social and Medical Complexity data releases ✔ Health-related services and other payment structures ✔ Transformation Center strategies-plans for technical assistance ✔ Public Health strategies-plans for strategic health improvement

• Must not derail existing pilots and progress being made toward increased

standardization of measures

19

RWJ National Funder for SDOH says states must accomplish a checklist of actions to make advances

• Identify and work with partners—OHA is doing this piece

✔ OPIP, ✔ DHS, ✔ Data warehouse, ✔ Transformation Center, ✔ OHSU, ✔ Food Banks

• Access existing sources of Data—OHA is doing this piece with OHSU health

complexity work

• Use literature and qualitative data—doing this right now by researching other

state approaches

• Analyze risk factors predictive or health and outcomes—Yet TO DO
• Get health care “used to working with” social determinants data in the

medical sphere—OHA is doing with existing DHS-OHA Health Screenings for Foster Children metric

20

Tip of the point metrics examples:

• Developmental screening
• Access to services
• Colorectal cancer

screening Metrics that are “Pointy” are:

• Focused
• Evidence-based
• Single domain or specialty
• Often comparable to normative data
• Exact
• Equality based

“Pointy” Metrics The basis for incentive and quality measures so far

Social determinants require “ROUND” metrics

Early Childhood Pollution-Clean Water Housing Stability Food Security Justice and Laws Educational Systems Employment Level Poverty and Wealth Gender Income Levels Family Support Crime Levels Medical Access Race Ethnicity

Member and Family In Community

Round measures are:

• Multiple domains
• Based on relationships
• Infrastructure
• Opportunities
• Community
• Qualitative
• Equity based
• Not normative

Close in to member and family are personal things like a job and permanent living space. Distant are things like neighborhood or census tract rates of crime, graduation rates Pointy metrics get dropped into this space, such as the blue triangle = Access to care from CAHPS

Adapted from: https://www.researchgate.net/publication/254262096_Social_determinants_of_health_and_the_future_wellbeing_of_Aboriginal_children_in_Canada/figures?lo=1

Social Determinants of Health is about Communities

23

We need to ….

• Identify a “culture of health”
• Identify the network and leaders in the community -----

a new infrastructure to bridge medical-social organizations

• Connect services in communities to improve health inequities as a result of lack of nutrition and food

sources, housing, safety, education, employment, clean air and water, as well as other factors.

• Overall complex social factors cannot be solved by the medical profession alone but bridges can be

built across sectors.

• Data are needed to help identify gaps in all of these needs
• Eastern states have created multiple domain and sector measures. Did a scan of four states:

Minnesota, Massachusetts, Michigan, Rhode Island

https://www.rwjf.org/en/library/features/culture-of-health-prize/2016-winner-louisville-ky.html Center for Health Care Strategies-Social determinants of health

Lessons from all States and Potential for Adaptation

• Social determinants is larger than a single measure
• Metrics are often reported out at both member and community levels
• Screeners are done at CCO or clinic levels. Requirements for measurement

do not get in way of novel ideas for local work and partnerships-usually agnostic as to the screener but lists out domains that must be measured

• Community infrastructure is developed through identifying service support

needs for that community using existing state and federal data by census tract

• r zip code (community level data) Member level is used for clinic/CCO work

process planning

• Roles and responsibilities for social referrals are described in detail and

connections to social services are updated and explicit

• Incentives and pay rates are at various levels of development
• http://www.jabfm.org/content/30/4/418.full.pdf+html – assessment of domains of screeners

24

Future of SDOH Measures for Oregon?

• Approval from HPQMC for expansion of focus toward broader domains
• Might require thinking of more rounded type measures that are qualitative in nature
• SDOH Model “structures” could be used either as an overall “score” in the incentive

program or as a methodology to create other SDOH payments- not sure how this will work in Oregon

• Many other groups are working on social determinants issues in Oregon so taking a

less prescriptive approach MIGHT be best as a first out of the gate approach as they are developing tools and strategies to help with more standardization as the area evolves—screener requirements are usually AGNOSTIC in these states

• Field not standardized but getting started seems important to momentum
• OHA has already started releasing child and family social information to CCOs and

could expand this activity while remaining agnostic to exact choices for screeners or a single measure type.

Discussion and Decisions

• Does the Metrics & Scoring Committee support shifting

this developmental work from food insecurity, specifically, to broader SDOH?

• If so, what are our next steps in terms of moving this

proposal forward to the HPQMC?

Obesity Metric Glidepath Update

Cat Livingston, MD, MPH Tom Jeanne, MD, MPH

Metrics & Scoring Committee Meeting November 16, 2018

11.2% 29.0% 0% 5% 10% 15% 20% 25% 30% 35% 40% 1990 1993 1996 1999 2002 2005 2008 2011 2014 2017

Obesity among Oregon adults, 1990–2017

Source: Oregon Behavioral Risk Factor Surveillance System Note: Vertical dashed line (---) indicates change in survey methods (2010). Estimates are age-adjusted.

Obesity has increased by over 150% since 1990

7.3% 11.4% 6.7% 13.7%

0% 2% 4% 6% 8% 10% 12% 14% 16%

2001 2003 2005 2007 2009 2013 2017

Obesity among Oregon youth, 2001-2017

8th grade 11th grade

Source: Oregon Healthy Teens Survey

Obesity among young children (WIC data)

32% 38% 41% 42% 43% 62%

Obesity among Oregon adults with selected chronic diseases and risk factors, 2017

Obesity in general population = 29%

Diabetes High Blood Pressure High Cholesterol Asthma Arthritis Heart Disease

Source: 2014 Oregon Medicaid BRFSS

The cost of obesity in Oregon

• 1. Obesity-related conditions such as heart disease

and diabetes cost Oregon about $1.6 billion ($339 million paid by Medicaid) each year in medical expenses alone.

• 2. People who are obese have annual medical costs

that are an estimated $1,429 higher than people who are not obese.

1. Trogdon, E, Finkelstein E, Feagan C, Cohen, J. State- and payer- specific estimates of annual medical expenditures attributable to obesity. Obesity. 2012;20:214-220 2.

• 2. Centers for Disease Control and Prevention. Vital Signs: State-Specific Obesity Prevalence Among Adults ---

United States, 2009. MMWR 2010;62:1-5.

What works to slow the increase of obesity?

Clinical interventions to slow the increase

• f obesity:

1: Intensive behavioral interventions (USPSTF)

• Minimum number of classes
• Minimum number of months

2: Bariatric Surgery (HERC CG)

https://www.oregon.gov/oha/HPA/DSI-HERC/Pages/Searchable- List.aspx?wp7687=se:%22obesity%22 https://www.oregon.gov/oha/HPA/DSI-HERC/EvidenceBasedReports/Metabolic-and- Bariatric-Surgery-CG.pdf

Multisector interventions to slow the increase of obesity (HERC MSI Statement)

1: School-based interventions 2: Community-level interventions

• Environmental Supports, Active

transportation strategies, workplace wellness 3: Policy change

• Sugar sweetened beverage taxes,

reduction in tax subsidies for unhealthy foods.

https://www.oregon.gov/oha/HPA/DSI-HERC/EvidenceBasedReports/Evidence-review- Multisector-Interventions.pdf

Last update 12/2017

Obesity Glidepath Workgroup Members

Name Affiliation

Tom Jeanne, MD, MPH

Deputy State Health Officer Oregon Health Authority, Public Health Division

James McCormack

EHR Technical Expert COIPA (Central Oregon Independent Practice Association)

Bhavesh Rajani, MD

Yamhill CCO

David Hopkins, MD

Community Guide Centers for Disease Control and Prevention

Miriam D. McDonell, MD

Health Officer North Central Public Health District Wasco Childhood Obesity Reduction Community Action Plan

Cat Livingston, MD, MPH

Associate Medical Director Health Evidence Review Commission

Deb Rumsey

Executive Director Children’s Health Alliance

Jen Johnstun

Primary Health of Josephine County

Anna Warner

Western Oregon Advanced Health

Obesity Glidepath Workgroup: Recommended Obesity Metric Child and adult obesity

• Ages 3 and up

Two part measure

• Part 1: Investments in

multisector interventions

• Part 2: Document BMI and

Referral to intervention; Follow-up on referral

Metrics Technical Advisory Group supports this metric

✓ Presented to TAG in Aug 2018 ✓ TAG supports one bundled measure with two parts that are rolled out separately over three years.

• Glide path to introduce Part 1/ Multisector Interventions in 2021 (year 1) and

add BMI measurement change to the measure in 2023 (year 3)

Obesity Glidepath Workgroup Recommendations

• Technical Specification Workgroup 1: Community

investment in multisector interventions

• The denominator will be the CCO.
• Criteria for investment should include prevention and/or

treatment and can be either clinical and/or community based.

• Consider if the CCO selects an intervention other than

what is listed on the HERC guidance: what documentation would be necessary?

• The subgroup should explore potentially adding an aspect
• f identifying the impact of the investment as part of the

attestation process.

41

• Technical Specification Workgroup 2: BMI

measurement and prevalence outcomes for children and adults.

• CCO population with elevated BMI (overweight or obese)

and look to reduce (average?) BMI among this population

• ver time (denominator = all CCO members age 3+ with

elevated BMI)

• CCO population within a healthy weight range and look to

increase that percentage over time (denominator = all CCO members age 3+)

• CCO population at normal or elevated BMI (overweight or
• bese) and look to reduce (average?) BMI among this

population over time (denominator = all CCO members age 3+ with normal BMI + elevated BMI)

42

Obesity Glidepath Workgroup Recommendations

Next Steps

• OHA will convene the Multisector Technical Specification

workgroup in early December.

• Test and pilot the community-based measure in spring

2019

• Members of the technical specifications workgroup

include:

– Cat Livingston, MD, MPH (OHA HERC), Tom Jeanne, MD, MPH (OHA PHD), Mimi McDonnell, MD (North Central Public Health), Lisa Bui, MBA (OHA Quality) – Staff: Kirsten Aird (PHD) and Kristin Tehrani (HPA)

• OHA will convene the BMI Technical Specification workgroup in

early 2019.

43

Thank You. Questions?

44

45

Time for a break

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

November 16, 2018

46

• A time of opportunity
• Workgroup process
• Final workgroup recommendations
• Measurement strategy proposal
• Next steps
• Request to the Metrics and Scoring Committee
• Additional needed work

Agenda

47

• Governor Kate Brown has prioritized young children prenatal to age 5
• The Governor’s Children’s Agenda, released in September 2018 and

informed by the cross-agency Children’s Cabinet, identifies priorities focused

• n health, early learning, human services, and housing supports.
• Oregon’s Early Learning Council is undergoing strategic planning to improve the

system and services that promote early learning

• Oregon Health Policy Board has adopted policy recommendations for CCO 2.0,

including key elements focused on improving children’s physical, oral, and behavioral health outcomes and value-based care.

• National landscape is evolving, with great attention on Oregon

A Time of Opportunity

48

Workgroup Charge

49

What is the health sector’s role and responsibility for achieving kindergarten readiness for Oregon’s children? Recommend one or more health system quality measures that:

• drive health system behavior change, quality

improvement, and investments that meaningfully contribute to improved kindergarten readiness

• catalyze cross-sector collective action necessary for

achieving kindergarten readiness

• align with the intentions and goals of the CCO

metrics program

Health Sector’s Role

Kindergarten Readiness

Workgroup Composition

50

• Workgroup members included:
• CCO representatives
• Pediatric care providers
• Early learning hub and early learning program representatives
• Behavioral health and oral health expertise
• Health care quality measurement expertise
• Representatives of families and CYSHCN
• Workgroup convened by Children’s Institute and the Oregon Health Authority,

with support from consultants:

• Colleen Reuland, Oregon Pediatric Improvement Partnership
• Diana Bianco, Artemis Consulting

51

Workgroup Process

51

52

March - May

• Reviewed

background, including family focus group findings

• Developed

conceptual framework for health aspects of kindergarten readiness

• Developed measure

criteria June - August

• Identified priority

areas of focus

• Reviewed and

assessed existing metrics that could be implemented in near- term

• Discussed interest in

new metrics for development

September - November

• Narrowed options to

13 priority metrics

• Explored options for

measurement proposals

• Built consensus on

measurement strategy proposal and implementation

• ptions

All children arrive at kindergarten with the skills, experiences, and supports to succeed.1

Working Definition of Kindergarten Readiness

53

▪ Supports include assistance and services to families that promote family stability and functioning. ▪ Succeed refers to children making progress toward educational goals set by families and schools. Goals should be tailored to the individual child to

• ptimize educational experience and outcomes.

1 Early Learning Council Strategic Plan 2015

54

Conceptual Framework for Health Aspects of Kindergarten Readiness

55

Current CCO Incentive Metrics by the Conceptual Framework

56

Health Aspects of Kindergarten Readiness Measure Criteria

57

Health Aspects of Kindergarten Readiness Priority Areas

58

Health Aspects of Kindergarten Readiness Priority Metrics

59

Soliciting Stakeholder Input

Stakeholder input was solicited through a broad invitation for public comment as well as through targeted engagement of stakeholder groups:

• Metrics and Scoring Committee
• CCO Metrics Technical Advisory Group
• Health Plan Quality Metrics Committee
• Early Learning Hubs
• Primary Care Providers
• Families

60

Themes from Stakeholder Input

Include at least one metric in recommendations that can be implemented in 2020 Excitement about metrics on dental services, mental health services, and developmental screening follow-up Focus on the children who face disparities Caution against screening metrics (e.g. SE screening), given challenges with capacity and access to services Summarize evidence for how recommendations will impact kindergarten readiness Connect recommendations to aligned work underway (e.g. CCO 2.0 priorities)

Caution against bundled metrics with many metric components

61

Final Workgroup Recommendations

Context for Recommendations

62

The role of the health sector is to provide family-centered and integrated services, and to work collaboratively with other sectors to ensure children are physically, socially, and emotionally healthy in preparation for kindergarten.

• A comprehensive approach to improving kindergarten readiness includes:
• an array of measures to drive progress in all domains of kindergarten readiness
• sufficient resources
• greater capacity for services and system-building
• Kindergarten readiness must continue to be a statewide priority; measures applied

through the CCO Quality Incentive Program should be just one of many coordinated and mutually reinforcing efforts to improve kindergarten readiness.

Why a Measurement Strategy

63

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.

64

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

• ld

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

65

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

Health Aspects of Kindergarten Readiness Measurement Strategy Proposal

66

Preventive dental visits for children 1-5 years old

• Description: Percentage of children ages 1-5
• n Medicaid who received preventive dental

services from a dental provider in the measurement year.

• Measure Developer: CMS EPSDT – Form

416, Modified by OHA

• Data Source: Medicaid claims
• Mean Score on HAKR Measure Criteria

When Assessed by Workgroup Members: 10.8 (out of 13)

67

Well-child visits for children 3-6 years

• ld
• Description: Percentage of children

ages 3-6 that had one or more well-child visits with a primary care provider in the measurement year.

• Measure Developer: National Committee

for Quality Assurance (NCQA)

• Data Source: Medicaid claims
• Mean Score on HAKR Measure Criteria

When Assessed by Workgroup Members: 8.62 (out of 13)

68

• Purpose: Drive CCOs to address complex system-level factors that impact the services that kids and

families receive and how they receive them, and for which there may be payment or policy barriers that need to be addressed.

• Activities: Build capacity within CCOs for enhanced services, integration of services, cross-sector

collaboration, and future measurement opportunities.

• Focus: Social-emotional health
• Components of a CCO-level attestation metric:

1) Examine and expand screening for and identifying factors that impact SE health (including SDOH). 2) Assess capacity and utilization of behavioral health services for children 0-5 and their families. 3) Address policies and payment for behavioral health services (within primary care and specialty behavioral health care) for children 0-5 and their families.

CCO-level attestation metric focused on social- emotional health

69

Components of a CCO-level attestation metric and example activities:

1) Examine and expand screening for and identifying factors that impact SE health (including SDOH). a. Conduct cross-sector training on identifying SE delays and follow-up pathways. b. Develop and implement specific pilots to address access of SE health services

• Pilot enhanced assessment of a child’s social emotional health and/or family factors
• Evaluate whether enhanced assessments result in increased access of behavioral health

services, and the impact of services on child and family well-being 2) Assess capacity and utilization of behavioral health services for children 0-5 and their families. a. Assess the specific number of trained providers and their capacity to provide behavioral health services for children 0-5, including mapping capacity by geography, language, and race/ethnicity. b. Examine claims data on utilization of behavioral health services for children 0-5 and assess for disparities. 3) Address policies and payment for behavioral health services (within primary care and specialty behavioral health care) for children 0-5 and their families. a. Address payment policies that limit access to services, such as:

• Prior-authorization requirements for behavioral health services, including those provided in an

integrated primary care clinic.

• Requirements for specific diagnostic codes to be provided for behavioral health services based
• n where the services is provided.

70

(Future) Child-level metric focused on social- emotional health

Examples: SE screening, Screening for SDOH and/or family factors that impact SE health, Preventive care bundle, Behavioral health services for children, Metrics for CYSHCN

Drives toward the development

• f a future child-

level metric

CCO-level attestation metric focused on social- emotional health

71

• Description: Percentage of children screened with a standardized developmental screening tool and

identified at-risk for developmental, behavioral and social delays who received follow-up steps to address delays identified. Three versions of the metric are available that vary by what follow-up counts.

• Measure Developer: Oregon Pediatric Improvement Partnership
• Data Source for Version Presented: Medicaid charts, Electronic Health Record reported metric
• Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 11.5 (out of 13)
• Relevant Data:
• Medicaid Performance Improvement Project within eight Medicaid MCOs in Oregon: Overall, only 40% of

children identified at-risk received follow-up; large variation in rates by MCO: 0-63%.

• Medical chart reviews as part of quality improvement projects in seven practices (currently in process with

five more): Baseline ranges: 30-68% received follow-up. For a majority of the practices, the rates of follow- up were between 29-40%.

Follow-up to developmental screening

72

The workgroup believes that this proposal will galvanize significant progress on kindergarten readiness:

• Catalyze health system integration and care coordination for children across physical, behavioral, and oral

health.

• Address multiple interrelated domains of child development, thereby maximizing the potential to improve the
• verall outcome of kindergarten readiness.
• Advance the provision of essential preventive services for all children as well as targeted services for children

and families with additional needs.

• Create a clear focus on social-emotional health, an area of great need articulated by families, health care

providers, and early learning and K-12 education stakeholders.

73

The proposed measurement strategy also aligns with the goals and criteria of the Metrics and Scoring Committee:

• Addresses gaps in the current measure set by domains, populations, and service lines.
• Includes a feasible total number of metrics and staggered roll-out to minimize burden while maximizing impact
• Presents a significant opportunity for quality improvement.
• Includes metrics that, when developed, are likely to be adopted by the Health Plan Quality Metrics Committee.
• Has high transformative potential and promotes increased value: improved health and development in early

childhood will impact lifelong health, education, and economic outcomes for all Oregonians.

74

Next Steps

Implementation Recommendations

75

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.

Implementation Recommendations

76

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.

Next Steps Requested of the Metrics and Scoring Committee

77

➢ 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

Additional Next Steps to Ensure Impact

78

• If endorsed by the Metrics and Scoring Committee, move

forward with needed measure development work.

• Address other priorities that emerged and barriers identified by

the workgroup.

• E.g. desired future measures, needed policy and funding to

ensure capacity of services, alignment with CCO 2.0 and Early Learning Council Strategic Plan, etc.

• Communicate about the workgroup and share lessons learned

to inform other states and advance efforts nationally.

Questions and Comments Welcome

Elena Rivera, MPH Senior Health Policy & Program Advisor Children’s Institute elena@childinst.org Dana Hargunani, MD, MPH Chief Medical Officer Oregon Health Authority DANA.HARGUNANI@dhsoha.state.or.us

79

THANK YOU!

80

Health Aspects of Kindergarten Readiness Workgroup webpage: http://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx

Review HPQMC measure selection criteria

81

81

Future Meeting Locations

82

• December 2018: Portland
• January 2019: Wilsonville
• February 2019: Portland
• March 2019: Wilsonville
• April 2019 on: Portland

82

Wrap-Up Next Meeting: December 14 14, 2018 in PORTLAND

83

83

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

84

85

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)

86

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

87

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