Metrics & Scoring Committee July 20, 2018 HEALTH POLICY & - - PowerPoint PPT Presentation

HEALTH POLICY & ANALYTICS Office of Health Analytics

Metrics & Scoring Committee

July 20, 2018

2

Today’s Agenda

 Welcome  Extended CCO 2.0 update  2018 incentive measure program changes  2019 measure set selection (June follow-up)

– Smoking cessation – Potential substance use disorder metrics (SBIRT; initiation and engagement in alcohol or other drug treatment)

 Finalize 2019 measure set!!!

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

Thank you, Ken, Karen, and Thomas!

3

Review June Minutes

4

5

Health Plan Quality Metrics Committee Updates

• No July meeting
• Next meet August 8, 2018
• Metrics summit scheduled for September 7, 2018

Measure Development Work

6

7

Obesity Metric Workgroup

• Met for the second time on June 25th. Discussed high

level, glide path concept.

• Working to create a measure that

– Addresses obesity in both children and adults – Is comprised of two components

• Community-based work
• Clinical
• Next meet on 23 July and will explore potential phased

measure comprised of above components

• Plan to engage TAG in August

8

Health Aspects of Kindergarten Readiness

• Last meeting was 29 June

– Concluded initial assessment of potential ‘ready’ metrics (those with fully tested and validated specifications) – Began assessment of ‘near ready’ metrics (specifications

developed, has been applied in some setting, but not at a CCO/MCO/health system level; data connections need work)

• Next meet on 27 July

– Will continue review of near-ready measures – As time allows, may discuss potential glide path/phased

• ptions

HEALTH POLICY & ANALYTICS Office of Health Analytics

9

Public testimony

Metrics & Scoring Committee July 20, 2018

Timelines

11

March April May June July August Sept Oct Nov Dec

2018

March 6 Oregon Health Policy Board

(OHPB) 3/15 Introductory Webinar on CCO Development of draft policy recommendations Review/refinement of policy recs

PHASE I

Operationalizing recommendations

CCO 2.0 Policy Development Timeline

Topic Area Work Plans Developed

MILESTONES

June 5 OHPB EXTENDED PUBLIC COMMENT Aug 7 OHPB

Public Meetings

Draft Policy Recommendations Developed Final Policy Recommendations Review Online survey open for 2.0 feedback

Public input collected for policy development phase

PHASE II PHASE III

Public Input on proposed recs Public input summarized for OHPB review Oct 2 OHPB CCO 2.0 Final OHPB review Policy options reviewed and discussed at existing public committee meetings

Tribal Engagement March 1 Meeting: Overall Timelines/ Structure Presented April 11 Meeting:

• Review tribal

engagement plan

• Identify Tribes wanting

1:1 consultations

• Share work plans
• Request written feedback
• n any initial ideas they’d

like for consideration May Meeting: Tribal webinars in each of the four topic areas on the policy

• ptions

June/July Monthly Meetings:

• Review feedback from

Tribes

• Discuss 1st straw

proposal

Individual 1:1 tribal consultations Statewide Forums

August Meeting: Review draft OHPB report

Written Comments Due

CCOs will be selected through a Request for Application (RFA) process

• Only current CCOs and companies with an existing Oregon “footprint” can apply
• Considering asking applicants to apply for regions with an option for current CCOs

to apply for their current service area

CCO 2.0 timeline

Public Input

14

15

CCO 2.0 Public Forums and Road Show

16

In-person

• Discussion at 25+ health committee meetings
• Oregon Health Policy Board meeting updates/public testimony
• Presentations at 20+ conferences and meetings
• 2 formal tribal consultations
• 13 Community Advisory Council meetings, hosted by IAs
• April/May public forums (4 events)
• June road show (10 locations)

Online

• Currently open online survey (mirrors the road show experience)
• March/April online survey (1568 respondents)
• Emails to CCO 2.0
• 25 letters/comments from organizations (posted online)

CCO 2.0 public input opportunities to date

17

What we’ve heard: Top OHP priorities

Looking to the future of CCOs, or what we call “CCO 2.0”, which of the areas need more attention and work to improve?

All survey takers: 928 (61.8%) of respondents ranked behavioral health care as one of the top 3 areas that needs attention.

Metrics-specific feedback (survey #1)

SUMMARY: Recognition that the incentive measures work, but have other consequences too; suggestions for new or improved metrics; comments

• n how CCOs should use the funds earned from achieving the incentive

measures (93 comments)

• “The incentive metrics seem like pretty low-hanging fruit in some cases. We

need to push CCOs harder for better outcomes/lower cost.”

• “When CCO's are offered incentives to pay particular attention to one
• utcome it often creates an overload in another area. For example, when

CCO's were incentivized on developmental screens for children it increased the number of children screened and referred for services but no increase was given to those providing the services. The incentives should be reinvested into the community-based organization providing the service to help meet the new increased demand.”

• “Any incentives given should have a percentage that must be reinvested

in an area that was impacted by that focus.” 18

Policy Development

19

Direct - Metrics Related Policies

• 1-4 Encourage CCOs to share financial resources with non-clinical

and public health providers for their contributions to incentive measures, through clarifying the intent that CCOs offer aligned incentives to both clinical AND non-clinical providers with quality pool measure areas

• 1-4 Encourage adoption of SDOH, health equity, and population

health incentive measures to the Health Plan Quality Metrics Committee and Metrics & Scoring Committee for inclusion in the CCO quality pool

20

INDIRECT - Metrics related policies

• 2-7 Require BH outcome measures or metrics for research based

practices

– Update OHAs recommended BH clinical practices – Incentivize use of BH best practices and emerging practices, including:

• Development of a Train the Trainer investment in BH models of care
• Supporting providers in utilizing ACEs score, outcome based tools and/or

trauma screening tools to develop individual service and support plans

• 3-4 Identify metrics to track milestones of BH and OH integration

with physical health care by completing an active review of each CCOs plan to integrate services that incorporates a score for progress

– OHA to refine definitions of BH and OH integration and add to the CCO contract – Increase technical assistance resources for CCOs to assist them in integrating care and meeting metrics 21

INDIRECT – Metrics related policies

22

• 2-9 Develop incentives for CCOs to meet the complex health needs
• f children and young adults
• 4-6 *Increase the portion of hospital payments that are based on

quality and value

– Incorporate quality and value measures in calculating reimbursement to hospitals (includes CCO and OHA directed payments)

• 4-7 Adjust the operation of the CCO Quality Pool to allow

consideration of expenditures in CCO rate development in order to:

– Align incentives for CCOs, providers, and communities to achieve quality metrics – Create consistent reporting of all CCO expenses related to medical costs, incentive arrangements, and other payments regardless of funding source (Quality Pool or global budget)

23

CCO 2.0 and OHPB: The big picture

July

• Bringing it all together

Aug

• Policy prioritization
• Review report outline

Sept

• Review draft report and

recommendations

Oct

• Approval of final report

24

• 1. Partnering with communities to support health and

health equity

• 2. Providing equitable, patient-centered care
• 3. Measuring performance and efficiency
• 4. Paying for outcomes and value
• 5. Financial sustainability and strategic investment

(sustainable rate of growth)

• 6. Transparency and accountability in price and quality

Goals of the Coordinated Care Model

25

Step 1: Assessment of…

– whether the policy was fulfilling a state or federal requirement; – connection to other policies and topic areas; – inclusion in current contract; – if legislation would be needed; – any additional development needed; – potential to reduce health disparities; – whether the policy corrected a process or identified an outcome; – potential impact on health system, OHA, and provider costs; – impact on procurement process; – risks; and, – timelines.

Feasibility and Impact Analysis - Process

26

Step 2: Overall estimation of…

• Feasibility – In general, how heavy is the “lift” for this this

policy across the system?

• Impact – In general, how much does this policy move the

needle in achieving the goals of the model?

Feasibility and Impact Analysis - Process

27

Final report draft outline:

– Vision of CCO 2.0 – Goals of the coordinated care model – Prioritized policy recommendations, including:

• Any sequencing needed
• Contract changes needed in year 1
• Legislation or support needed from Legislature and Governor
• Operational changes for OHA

– Appendices:

• Additional goals and opportunities that have surfaced through this process

(not necessarily CCO 2.0)

• Promising policies that need additional development work
• Housekeeping changes to contracts

CCO 2.0 Final Report Framework & Reflections

For more information on CCO 2.0 visit: www.health.oregon.gov Questions, comments, or recommendations?

Email CCO2.0@state.or.us

Thank you!

28

2018 Incentive Measure Program Changes

29

30

2018 Incentive Measure Program Changes

• Given changes to CCO composition in 2018, OHA would like to identify a

set of modifications to be implemented for any CCO experiencing extraordinary capacity changes now, or in the future.

• The intent and design of the incentive dollar pool is based on the idea of

a bonus that would be paid for transformations through quality improvement in care.

• Where rule changes are made to the incentive payment program rules, it

should only be due to large, unplanned, and sudden events that impact CCO capacity.

31

2018 Incentive Measure Program Changes

• The options under consideration on the next slide would be implemented

based on significant policy or business changes that occur in a single calendar year. As background:

– During Medicaid expansion in 2014, for example, CCOs expanded between 45% to over 100% during a planned addition of many new members. – In any single 12 month year, under normal fluctuation conditions, CCO membership goes up and down between 1 and 3% from month to month. – In 2018, Health Share had its membership increase by ~54%, WVCH by ~6%, and Yamhill by about 100 members.

• Given this, the Metrics & Scoring Committee could consider a threshold
• f a 45% single year increase in order to make any of the program

change options on the next slide.

32

2018 Incentive Measure Program Changes – Options

• In all options below, Minnesota method and improvement target floors are

not applicable Description Population Used to Rebase Targets

Option 1

Hold previous performance steady, rebase. Final performance from year BEFORE increase becomes target for year in which increase occurs.

• New target = performance in previous year, but

recalculated ("rebased") to give proxy of what previous performance may have been with inclusion

• f new members

CCO population from previous year, augmented to include new members (i.e., recalculate previous performance to estimate performance with new members)

Option 2

Hold previous performance steady, NO rebase. Final performance from year BEFORE increase becomes target for year in which increase occurs.

• New target = performance in previous year, with no

recalculation n/a

Option 3

Hold previous targets steady, no rebase. Final targets from year BEFORE increase carried forward as target for year in which increase occurs.

• New target = same target as in previous year

n/a

2019 measure set: Information for consideration (June follow-up)

33

Smoking Prevalence Measure

Kate Lonborg Clinical Quality Metrics Registry (CQMR) Program Manager Office of Health IT and Office of Health Analytics Health Policy and Analytics Division Kirsten Aird Cross Agency Systems Manager Health Promotion and Chronic Disease Prevention Section Public Health Division

Follow-up from earlier discussion

• Can we use NQF0028 (tobacco use screening and

cessation intervention) and add adolescents?

– Larger change to metric than changing age range (e.g., different visit types coded for adolescents v. adults) – Difficulty in feasibility of reporting and consistency with HPQMC menu

• Other measures of adolescent tobacco use?

– Staff researched existing measures; did not find adolescent- specific measures that are viable for 2019

• Neither our current smoking prevalence measure nor the

measure captures e-cigarette use

35

Current Adolescent Tobacco Use

Public Health Division Health Promotion and Chronic Disease Prevention Section

• In 2017, 8.4% of Oregon 8th graders and 18.9% of 11th graders

used any type of tobacco product (Oregon Tobacco Facts: https://apps.state.or.us/Forms/Served/le9139.pdf)

• Patient-level data (2016) from some clinics for CCO smoking

prevalence measure reporting showed the smoking rate in adolescents to be 2.8%

Unique characteristics of adolescent smokers

Public Health Division Health Promotion and Chronic Disease Prevention Section

Nearly all smokers (9 of 10) start before the age of 18 What makes this population different from adults?

– While cigarette smoking is decreasing, e-cigarette use in increasing – Tobacco industry markets appealing flavors to kids – New product use (juul) – Many youth see themselves as non-addicted (low reporting) – Effective cessation treatments are limited

• No medication approved by FDA
• Studies are of established smokers only
• Behavioral interventions only slightly effective

What works for prevention and treatment in adolescents?

Public Health Division Health Promotion and Chronic Disease Prevention Section

Evidence-based practices can prevent kids from starting to smoke (from CDC Community Guide):

• Higher cost (i.e. tobacco taxes)
• Smoke-free laws
• Raising the minimum age to 21
• TV, radio and other media to counter tobacco industry ads
• Community and school policies to encourage tobacco-free lifestyles
• Reducing advertising and availability
• Behavioral counseling in school and communities (USPSTF)

MULTISECTOR INTERVENTION NOTES

Public Health Division Health Promotion and Chronic Disease Prevention Section

MULTISECTOR INTERVENTION 1: COVERAGE GUIDANCE

To reduce the use of tobacco during pregnancy and improve associated

• utcomes, the evidence supports the

following interventions:

• Financial incentives (incentives

contingent upon laboratory tests confirming tobacco abstinence are the most effective)

• Smoke-free legislation
• Tobacco excise taxes

Staff Recommendation

Recommendation Rationale

Use NQF-endorsed tobacco use screening and cessation intervention measure to calculate tobacco prevalence

• Improve data validity and

consistency in reporting

• Separate data on adult population
• Align with commonly used standard

measure (MU, MIPS, CPC+, UDS) “Restart” minimum population threshold at 25%

• Allows time to build reporting

capacity Require reporting only for 2019

• Allows time to build reporting

capacity before benchmarking

• Collects baseline data for 2020

improvement targets

40

Tobacco Use: Screening and Cessation Intervention (2018)

Substance Use Disorder Measure Options

42

43

SUD Measure Options

• At its last meeting the Committee heard about public health interest in

incentive measures on substance use disorder.

• Previously, the Committee tentatively voted to include the EHR-sourced

SBIRT measure in the 2019 incentive measure set, but wanted to hear more before making a final decision.

• The Committee also briefly discussed the Initiation of alcohol or other

drug treatment measure (IET) as a possible SBIRT alternative.

• The IET measure is the percentage of adolescent and adult patients with

a new episode of alcohol or other drug dependence (AOD) who:

– initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and – initiated treatment and who had two or more additional services with a diagnosis of AOD within 34 days of the initiation visit

44

SUD Measure Options - Considerations

• IET

– Which component is benchmarked (or both)?

• SBIRT

– The U.S. Preventive Services Taskforce (USPSTF) recently released the following draft recommendation regarding SBIRT:

• General

– Does the Committee want to focus on prevention/early detection (SBIRT), or access to care for those with a disorder (engagement and treatment)? – Both measures relate to general substance use disorder, not opioid use disorder (though beginning in 2018 IET specs break out performance by

• pioid, alcohol, or other drugs).

45

46

47

48

Report Back EHR-based SBIRT Measure

Metrics and Scoring Committee July 20, 2018 Kristin Tehrani Katherine Castro Kate Lonborg 49

Objectives

• 1. Provide more detail on measure specifications
• 2. Providing more information on capturing a brief intervention

50

SBIRT Pilot Test Project

Purpose Test the measure specifications proposed by the SBIRT work group Test the capability of producing SBIRT reports using different EHRs and clinics without making system or workflow changes Key Findings

• SBIRT as an EHR-based measure is feasible.
• Report production varies by EHR system.
• For OCHIN Epic users, Rate 1 can use existing Depression Screening reports.
• Rate 2 is more difficult than Rate 1 to produce.
• Most clinics will need to develop custom query reports, especially for Rate 2.
• The 2-month period for follow-up (brief intervention or referral to treatment made)

proposed in draft specifications is inconsistent with most clinic work flows and seemed unnecessary.

51

Implementation of the measure specifications A Clinical Perspective

Katherine Castro Consulting Analyst, PRM Analytics to Advanced Health

52

53

All patients aged 12 years and

• lder before the beginning of the

measurement period with at least 1 eligible encounter during the measurement period Denominator 1 (D1) SBIRT BRIEF screen COMPLETED Negative Result COUNTS as Numerator 1 (N1) Positive Result SBIRT FULL screen COMPLETED COUNTS as Numerator 1 (N1) Negative Result DONE Full Screen COMPLETED Positive Result Denominator (D2) DOCUMENTED Within 48 hours Brief Intervention, Referral to Treatment,

• r Both

Numerator 2 (N2)



SBIRT Flowchart

Rate 1 Rate 2

2019 SBIRT EHR-based Measure Specifications

What constitutes a positive result on screening?  Clinician judgment on scoring What is required for documentation of Brief Intervention?  Some kind of checkbox, flowsheet or other structured data in the EHR  Not looking for particular billing codes to meet the metric

54

55

?

Questions

56

Time for a break.

Select 2019 Measure Set (including challenge pool)!

57

Measure Consensus Include? Consensus Exclude? Notes

• 1. Adolescent well-care visits
• 2. Emergency department utilization
• 3. Assessments for children in DHS custody
• 4. Access to care (CAHPS)
• 5. Childhood immunization status
• 6. Cigarette smoking prevalence
• 7. Colorectal cancer screening
• 8. Controlling hypertension (EHR)
• 9. Dental sealants
• 10. Depression screening and follow-up (EHR)
• 11. Developmental screenings
• 12. Diabetes: Hba1c poor control
• 13. Disparity measure: ED utilization for members w

MI

• 14. Effective contraceptive use
• 15. PCPCH enrollment
• 16. Prenatal care
• 17. Weight assessment and counseling for kids and

adol. New?

• 18. Postpartum care
• 19. Adults with diabetes – oral evaluation
• 20. Drug and alcohol screening (SBIRT)
• 21. Initiation and engagement of alcohol or drug

abuse or dependence treatment

59

Wrap-Up Next Meeting: August 17, 2018

• Welcome new members
• Begin selecting 2019 benchmarks and improvement target

floors (to finalize in September)

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

60

61

2018 Incentive Measures

• 1. Access to care (CAHPS survey)
• 10. Dental sealants for kids

2.Adolescent well-care visits

• 11. Depression screening and f/u plan
• 3. Emergency department utilization
• 12. Developmental screenings****
• 4. Assessments for kids in DHS

custody****

• 13. Diabetes HbA1c poor control
• 5. Childhood immunization status****
• 14. Disparity measure: ED utilization for

members with mental illness

• 6. Cigarette smoking prevalence
• 15. Effective contraceptive use
• 7. Colorectal cancer screening
• 16. PCPCH enrollment
• 8. Controlling high blood pressure
• 17. Weight assessment and counseling

for kids and adolescents

• 9. Timely prenatal care****

****=challenge pool, (challenge pool focuses on early childhood health; Committee ultimately wants a measure of kindergarten readiness)

CCO Incentive Measures since 2013

62

CCO Incentive Measures 2013 2014 2015 2016 2017 2018 Adolescent well-care visits x x x x x x Alcohol or other substance misuse screening (SBIRT) x x x x Ambulatory care: Emergency department (ED) visits x x x x x x CAHPS composite: Access to care x x x x x x CAHPS composite: Satisfaction with care x x x x x Childhood immunization status x x x Cigarette smoking prevalence x x x Colorectal cancer screening x x x x x x Controlling high blood pressure x x x x x x Dental sealants x x x x Depression screening and follow-up plan x x x x x x Developmental screening (0-36 months) x x x x x x Disparity measure: ED visits among members with mental illness x Early elective delivery x x Diabetes: HbA1c poor control x x x x x x Effective contraceptive use x x x x Electronic health record adoption x x x Follow-up after hospitalization for mental illness x x x x x Follow-up for children prescribed ADHD medication x x Health assessments within 60 days for children in DHS custody x x x x x x Patient centered primary care home enrollment x x x x x x Timeliness of prenatal care x x x x x x Weight assessment and counseling for children and adolescents x

63

Waiver Goals

Governor’s Direction for CCO 2.0 Waiver - Four Key Goals (p. 10) Increasing value-based payment Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health-related services, advances the use of value-based payments; Focus on social determinants of health and equity Increase the state’s focus on encouraging CCOs to address the social determinants of health and improve health equity across all low-income, vulnerable Oregonians to improve population health

• utcomes;

Maintaining a sustainable rate of growth Commit to ongoing sustainable rate of growth and adopt a payment methodology and contracting protocol for CCOs that promotes increased investments in health-related services, advances the use of value-based payments; Improving the behavioral health system Enhance Oregon’s Medicaid delivery system transformation with a stronger focus on integration of physical, behavioral, and oral health care through a performance- driven system aimed at improving health outcomes and continuing to bend the cost curve; Expand the coordinated care model by implementing innovative strategies for providing high-quality, cost-effective, person-centered health care for Medicaid and Medicare dual- eligible members.

64

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

65

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

Oral Health Measures

67

Comparison of Oregon specifications versus DQA specifications (sealants)

68

Current CCO specifications DQA specifications Which teeth counted in numerator? Count all permanent molars Sealant must be on first molar (6- 9); second molar (10-14) Who is included in denominator? All children on Medicaid ages 6-14 meeting continuous enrollment criteria Only children at elevated caries risk are included, as identified by:

• Visit D0602 (moderate caries

risk) or D0603 (high caries risk) during measurement year

• Service code from a list of CDT

codes indicating restorative service in either the measurement year or in the 3 years prior to the measurement year

Comparison of Current OHA vs DQA Specs, 2017 (preliminary, unvalidated data)

70

Den. Num. Rate Den. Num. Rate ADVANCED HEALTH 2,327 644 27.7% 1,281 445 34.7%

• 45%

7.1% ALLCARE 6,635 1,582 23.8% 3,722 1,073 28.8%

• 44%

5.0% CASCADE HEALTH ALLIANCE- 2,244 492 21.9% 1,311 336 25.6%

• 42%

3.7% COLUMBIA PACIFIC CCO 3,225 759 23.5% 1,586 447 28.2%

• 51%

4.6% EASTERN OREGON CCO 7,866 1,930 24.5% 5,203 1,590 30.6%

• 34%

6.0% FAMILYCARE 15,509 3,591 23.2% 8,688 2,433 28.0%

• 44%

4.8% HEALTH SHARE OF OREGON 31,094 7,942 25.5% 18,718 5,607 30.0%

• 40%

4.4% INTERCOMMUNITY HEALTH NETWORK 7,513 1,782 23.7% 4,039 1,223 30.3%

• 46%

6.6% JACKSON CARE CONNECT 4,550 1,183 26.0% 2,790 824 29.5%

• 39%

3.5% PACIFICSOURCE GORGE 2,112 565 26.8% 1,156 376 32.5%

• 45%

5.8% PACIFICSOURCE CENTRAL 7,238 1,708 23.6% 3,972 1,265 31.8%

• 45%

8.3% PRIMARYHEALTH JOSEPHINE CO 1,051 235 22.4% 574 152 26.5%

• 45%

4.1% TRILLIUM COMMUNITY HEALTH PLAN 11,698 2,701 23.1% 6,164 1,811 29.4%

• 47%

6.3% UMPQUA HEALTH ALLIANCE 3,486 781 22.4% 2,016 558 27.7%

• 42%

5.3% WILLAMETTE VALLEY COMM. HEALTH 17,874 3,941 22.0% 9,982 2,702 27.1%

• 44%

5.0% YAMHILL COMMUNITY CARE 3,820 879 23.0% 2,259 656 29.0%

• 41%

6.0% STATEWIDE RATE 128,242 30,715 24.0% 73,461 21,498 29.3%

• 43%

5.3% DQA specs (elevated risk criteria) Current OHA CCO specs (no risk algorithm)

• Den. -

% change Rate - % Pt. Change CCO

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100 Dental sealants among children 6-9 and 10-14

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

184

185

186

187

188