Metrics Technical Advisory Workgroup March 24, 2016 PLEASE DO NOT PUT - - PowerPoint PPT Presentation

Metrics Technical Advisory Workgroup

March 24, 2016

PLEASE DO NOT PUT YOUR PHONE ON HOLD – IT IS BETTER IF YOU DROP OFF THE CALL AND REJOIN IF NEEDED

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Today’s Agenda

• Updates
• School‐Based Dental Sealant Program Update
• CCO Oregon Dental Metrics Workgroup

Presentation

• Measure Development
• Health Equity Index
• Food Insecurity Screening

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TA Bank Consultant Webinars

CCOs are invited to join TA Bank consultants to review

• pportunities for technical assistance. Consultants will share

their areas of expertise and examples of prior TA bank projects.

• Tuesday, March 29, 9 – 10 AM
• Thursday, March 31, 3‐4 PM (behavioral health integration only)
• Monday, April 4, 1‐2 PM
• Thursday, April 7, 3‐4 PM (behavioral health integration only)

Intended audience: QI coordinators, CAC coordinators, and

• ther CCO staff leading work in TA Bank topic areas.

http://www.oregon.gov/oha/Transformation‐Center/Pages/Technical‐ Assistance‐Bank.aspx

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Colorectal Cancer Screening TA

Webinar series:

Webinar #1: Screening Options for Colorectal Cancer – A Summary of the Evidence Behind Colonoscopy and Fecal Testing (FIT/FOBT)

• April 13, 11 AM – Noon
• https://attendee.gotowebinar.com/register/1068106650554228994

Individualized TA for CCOs:

• First webinar will introduce TA available
• Follow‐up calls with presenters

(Gloria Coronado & Melinda Davis)

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Year Three Data Submission

• Year Three Clinical Quality Metrics data due April 1st
• OHA will complete initial review within 10 business

days, and secondary review within 30 business days

• nce initial review is complete.
• If additional information is requested during review,

CCOs will have 10 business days to respond / resubmit.

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Year Four

• OHA is working on guidance document and

parameters for Year Four data submission.

• Population threshold is increasing to 65%.
• Seeking feedback about population threshold for new

tobacco measure. Thoughts?

• OHA will require at least one patient‐level data

submission.

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Dashboards & Data

• CCO Metrics Dashboard
• OHA will release March dashboard next week
• Will continue in April, etc.
• Also releasing ALERT IIS data in March
• Opioid PIP Data
• OHA provided Dec 2014 – Nov 2015 data last week
• Skipping April due to analyst leave
• Will resume in May, monthly thereafter

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2016 Specification Update

• Effective Contraceptive Use
• Added new HCPCS codes J7297 and J7298 to numerator

code table.

• Developmental Screening
• Clarified the period for the numerator and continuous

enrollment are the 12 months preceding child’s birthday.

http://www.oregon.gov/oha/analytics/Pages/CCO‐Baseline‐Data.aspx

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SBIRT Update

Please note: we will be updating the SBIRT guidance document to clarify that SBIRT services (CPT 99408 / 99409) can be documented with an E&M visit via modifier ‐25 by the same physician. The guidance document previously has stated that there is a separate provider requirement; this is no longer the case.

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Tobacco Prevalence Specification Clarifications (1)

• Previous discussion re: excluding members who do

not have their smoking / tobacco use recorded.

• New question: is this a numerator or denominator

exclusion?

• OHA proposes modifying the specifications to make

this more clear.

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Revised Measure

Denominator: all patients (100) Numerator: of all patients, how many have cigarette smoking or tobacco use status recorded (80) Result: 80/100 = 80% Denominator: all patients who have smoking/tobacco use status recorded (80) Numerator: of those, how many are cigarette smokers (18) Result: 18/80 = 22.5%* Denominator: all patients who have smoking/tobacco use status recorded (80) Numerator: of those, how many are smokers (18) or tobacco users (2) Result: 20/80 = 25%

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Tobacco Prevalence Specification Clarifications (2)

• Should we only be looking at smoking / tobacco use

status recorded at the most recent visit?

• Alternately, recorded any time during the

measurement year, even if not most recent visit?

• Alternately, recorded in some period prior to the

measurement year (e.g., 24 months to align with NQF 0028)?

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Certification for School Dental Sealant Programs

Oregon CCO Metrics Technical Advisory Workgroup March 24, 2016

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SB 660 Mandatory Certification

• Every Local School Dental Sealant Program must be certified

before dental sealants can be provided in a school setting beginning for the 2016-17 school year.

• A Rules Advisory Committee (RAC) assisted in drafting the rules

language.

• Final Administrative Rules, OAR 333-028, were effective January

29, 2016. The official language can be found online at: http://www.healthoregon.org/sealantcert − There are more requirements and new processes for certification than voluntary certification.

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Summary of Certification Requirements

• Coordinating representative must attend the one-time certification

training provided by the OHA Oral Health Program. − 3 certification trainings being offered this spring. − Webinar will be conducted Friday, April 8th for those programs that have already attended a certification training to go over the new processes and forms.

• Annual clinical training must been provided to all providers

rendering care within their scope of practice in a school setting. − Local sealant program may create their own training; or − Attend the OHA training being offered in August (date TBD)

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Summary of Certification Requirements

• Programs must contact CCOs operating in the community before

they initially contact any school to offer services. – OHA will provide CCOs with a list of schools being served and targeted based on the application form. – CCOs will work with OHA to sort out duplication of services. – OHA will hold a webinar with key contacts from each CCO and provide them with a decision-making tool.

• Medicaid encounters must be entered into the Medicaid system.
• Elementary and middle schools with 40% or greater FRL must be

targeted first.

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Summary of Certification Requirements

• Screening and dental sealant services, at a minimum, must be
• ffered to all students with parental/guardian permission

regardless of insurance status, race, ethnicity or socio-economic status.

• Services must be offered, at a minimum, to elementary school

students in 1st and 2nd grades or 2nd and 3rd grades.

• Services must be offered, at a minimum, to middle school students

in 6th and 7th grades or 7th and 8th grades.

• A plan to increase parental/guardian permission return rates must

be developed and implemented.

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Summary of Certification Requirements

• Dental equipment must be used on school grounds during school

hours.

• Parent/guardian permission forms must include a medical history.
• Providers must use the four-handed technique to apply sealants

in elementary schools.

• Providers must use the two-handed technique using an Isolite or

equivalent OHA approved device or the four-handed technique to apply sealants in middle schools.

• Resin-based sealants must be applied.

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Summary of Certification Requirements

• Comply with all scope of practice laws as determined by the

Oregon Board of Dentistry.

• Comply with Oregon Board of Dentistry oral health screening

guidelines.

• Comply with infection control guidelines established in OAR 818-

012-0040.

• Comply with HIPAA and FERPA requirements.
• Classroom time must be respected, and demands placed on

school staff must be limited.

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Summary of Certification Requirements

• Retention checks must be conducted at one year for quality

assurance.

• Annual data report must be submitted to the OHA Oral Health

Program. − Aggregate-level data will be required for each school.

• Certification logo must be included on all parent/guardian

permission forms and written communication to schools, or the schools are provided with a letter by the OHA Oral Health Program regarding certification.

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Certification Process

• Local school dental sealant programs will apply for initial

certification with the OHA Oral Health Program. – Certified – Provisionally Certified – Denied

• Certification year is August 1 – July 31.
• OHA Oral Health Program will conduct verification site visits.
• Programs must apply for renewal certification no later than July

15th of each year. – Data report must be submitted before applying.

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Contacts

Amy Umphlett Oral Health Operations & Policy Analyst (971) 673-1564 amy.m.umphlett@state.or.us Laurie Johnson School Oral Health Programs Coordinator (971) 673-0339 laurie.johnson@state.or.us

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Metrics and Scoring TAG Meeting March 24, 2016

Sara Love, ND Matt Sinnott, MHA

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CCO Oregon

• Non-profit membership organization

focusing on three key areas:

– Collaboration – Research, Analysis, and Reporting – Policy Development

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Workgroups

• Dental
• Integrated Behavioral Health Alliance of

Oregon

• Social Determinants of Health
• Pharmacy

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Dental Workgroup

Chair: Matthew Sinnott, MHA, Willamette Dental Members: Gary Allen, DMD, Advantage Dental Teri Barichello, DMD, ODS Christina Swartz Bodamer, ODA Tony Finch, Oregon Oral Health Coalition Alyssa Franzen, DMD, CareOregon Sean Jessup, Moda/EOCCO Deborah Loy, Capitol Dental Sharity Ludwig, EPDH, Advantage Dental Monica Martinez, JD, CareOregon Shanie Mason, MPH, CareOregon Mike Shirtcliff, DMD, Advantage Dental Heather Simmons, MPH, PacificSource Eryn Womack, InterCommunity Health Network CCO

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Challenges

• Multiple DCO-CCO contracts with different

quality measures

• Increased administrative burden for data

analytics team to provide accurate reporting

• Measures not always transformative or

relevant

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Process

• Monthly meetings, 60 minutes in duration
• Evaluate 140 different measures for

relevance and feasibility for both CCO and DCO

• Consideration for alignment with CCO

Quality Incentive Measures

• Final product of 20 measures approved

December 2015

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Process:

Striking a Balance

• Uniformity vs flexibility
• Core set with measures considered

minimum standards

• À la carte for coordination with local health

goals

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Results

• Appropriate age ranges
• Measures that are appropriate for oral

health goals and are transformative

• Measures that evaluate appropriate oral

health services

• Future measure considerations

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Core Set Measures

• Utilization
• Preventative Services
• CAHPS-Access to care and patient

evaluation

• Emergency Department utilization and

follow up

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À la carte Set Measures

• Fluoride varnish
• Tobacco use
• Services for pregnant women
• Diabetes and periodontal disease
• Exams/visits

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Approval

• Consensus approval from workgroup
• Policy Committee approval
• Board of Directors approval
• Voluntary agreement between member
• rganizations

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Next steps

• Encourage enactment of measures into

CCO-DCO contract amendments

• Determine implementation timeline
• Decide frequency of metric revisions

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Future

• Defining integration, coordination, access

for oral health

• Create a foundation of recommended

standards for oral health integration allowing for local flexibility, practicality and usability

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Questions??

• Contact information:

– Sara Love, ND – sara@ccooregon.org

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Measure Development

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Food Insecurity Screening: Recap

From February meeting:

• Prefer CCO‐level measure, focused on screening
• nly (with option to report follow‐up).
• Prefer flexibility in data source(s) – including EHR,

chart review, health risk assessment, and (last) surveys.

• Recommend measure become a PIP measure,

rather than incentive measure.

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Food Insecurity Screening: Updated Specifications (v4)

Updated draft specifications to reflect February

• conversation. Outstanding questions include:
• Denominator population?
• Continuous enrollment criteria?
• Other?

 Please send any other feedback on draft specifications to metrics.questions@state.or.us

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Health Equity Index: Recap

• Initial charge from Metrics & Scoring Committee to

create a “meta‐measure”

• Internal workgroup  slightly larger workgroup
• Initial presentation at November TAG meeting

http://www.oregon.gov/oha/analytics/MetricsTAG/ November%2019,%202015%20Presentation.pdf

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Proposed Framework for Index

Facets Measures Variable 1 Variable 2 Variable 3 Variable 4 Variable 5

Seeking Care

Measure 1

Each measure in the composite could be stratified in a variety of ways, including, but not limited to:

• Race / ethnicity
• Language
• Gender
• SPMI
• Disability
• Geography
• Etc…

Composite will likely start with race/ethnicity at minimum, then expand to include other variables. Access to Provider

Measure 2 Measure 3 Measure 4

Quality of Care

Measure 5 Measure 6

Differential Treatment based on Needs

Measure 7 Measure 8

Self‐Reported Health Status

Measure 9

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Current Methods for Index

• 1. Z‐Scores
• 2. Comparison to benchmark

(or improvement target)

• 3. Best in class

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Z‐Score Method

• Each measure in the index will be assigned a

standardized score (z‐score), which is based on the variation within a CCO.

• Z‐scores show how far away each group is from the

mean, i.e. the performance for a group relative to performance across all other groups within the CCO.

• Addresses complexity of existing measures (some are

%, some are rates, some are composites…)

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Z‐score example

Facets Measures Variable 1 Variable 2 Variable 3 Variable 4 Variable 5 TOTAL Seeking Care Measure 1 1 ‐2 ‐3 ‐4 ‐8 Access to Provider Measure 2 1 ‐2 ‐3 4 3 3 Measure 3 2 ‐1 4 ‐2 3 6 Measure 4 1 ‐1 ‐3 2 4 3 Quality of Care Measure 5 1 2 ‐2 ‐1 ‐1 ‐1 Measure 6 3 2 ‐2 ‐1 3 5 Differential Treatment based

• n Needs

Measure 7 ‐3 ‐4 4 ‐ ‐3 Measure 8 ‐1 1 2 1 3 Self‐Reported Health Status Measure 9 1 1 ‐1 1 TOTAL 6 ‐4 ‐7 6 8 9

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Z‐score pros & cons

Pros

• Allows for comparison

across multiple measures and multiple populations in a standardized way.

• Addresses complexity of

existing measures (rates, percentages, etc)

• Allows future flexibility –

substitution of measures, populations, etc.

Cons

• Small numerators at CCOs

for some populations and variables will need to be addressed (n<30)

• Methodology can be

confusing and total scores may not be meaningful.

• Unsure if index will be able

to detect movement in 12 months.

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Benchmark Method

• Rather than calculating z‐scores for each

population / measure, this method would use the established benchmark for the measure.

• Each population group within a CCO would be

compared to the benchmark and determined if they met / did not meet it.

• Since most benchmarks are aspirational, would also

calculate population specific improvement targets and use benchmark or improvement target.

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Benchmark example

Facets Measures Variable 1 Variable 2 Variable 3 Variable 4 Variable 5 Seeking Care Measure 1 Met Not Met Met N/A Not Met Access to Provider Measure 2 Met Not Met Not Met Not Met Met Measure 3 Not Met Not Met Not Met Not Met Met Measure 4 Not Met Met Met Met Not Met Quality of Care Measure 5 Not Met Not Met Met Not Met Not Met Measure 6 Not Met Met Met N/A Met Differential Treatment based

• n Needs

Measure 7 Not Met Not Met Not Met Met Not Met Measure 8 Met Met Met N/A Met Self‐Reported Health Status Measure 9 Not Met Met Not Met N/A Not Met TOTAL 3/9 = 33% 4/9 = 44% 5/9=55% 2/5= 40% 4/9= 44%

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Benchmark pros & cons

Pros

• Uses established

methodology that CCOs and stakeholders are familiar with.

• Met / not met is more clear

than z‐score value.

• May be more likely to move

in 12 month period.

Cons

• Benchmarks are national

and not necessarily appropriate for various populations, or to identify disparities.

• Method “re‐measures”

CCOs overall performance.

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Best In Class Method

• This method would look across all CCOs to find the highest

performing population on a given measure.

• For example, the highest performing white population on the SBIRT

measure in a CCO becomes the benchmark for the white population in the other 15 CCOs…

• Rather than setting separate benchmarks for each population,

which may send unintended messages, this compares to a known, and theoretically achievable, standard.

• By design, all but one CCO would be below the ‘best in class’, so

rather than met / not met, would score based on % distance from the ‘best in class’.

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Best in Class example

Facets Measures Variable 1 Variable 2 Variable 3 Variable 4 Variable 5 Seeking Care Measure 1 5% 1% 4% 25% 43% Access to Provider Measure 2 26% 3% 40% 0% 46% Measure 3 0% 8% 47% 49% 26% Measure 4 2% 24% 38% 29% 22% Quality of Care Measure 5 13% 5% 17% 36% 26% Measure 6 1% 17% 35% 37% 34% Differential Treatment based

• n Needs

Measure 7 9% 0% 47% 32% 21% Measure 8 57% 2% 28% 4% 21% Self‐Reported Health Status Measure 9 3% 15% 1% 18% 40% TOTAL (overall average) 12.9% 8.3% 28.5% 25.6% 31%

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Best in Class Pros & Cons

• Same as benchmark method, but adjusts

benchmark to a theoretically attainable goal.

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Benchmark example: SBIRT

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Best In Class example: SBIRT

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Challenge: Small Ns

Measure Measure Name Option RE_A: Number of CCOs with all R/E categories met denom >=30 Option RE_B: Number of CCOs with 4 or more R/E categories met denom >=30 ADHD Follow Up Care for Children Prescribed ADHD Medication (Initiation) * AMB_ED1 * Ambulatory Care ‐ Emergency Department Utilization (per 1,000 MM) 16 16 AMB_OP Ambulatory Care ‐ Outpatient Utilization (per 1,000 MM) 16 16 * AWC * Adolescent Well Care Visits 4 13 CCS Cervical Cancer Screening 3 11 CDC_HB Diabetes ‐ HbA1c Testing 1 4 CDC_LD Diabetes ‐ LDL‐C Testing 1 4 CHL Chlamydia Screening 3 * DEV * Developmental screening 3 4 * DHS * Assessments for Children in DHS Custody * DS * Dental Sealants ‐ All Age Groups 5 12 * ECU1850 * Effective Contraceptive Use ‐ Ages 18‐50 3 9 * FUH * Follow Up After Hospitalization for Mental Illness (7‐Day) PCR1 Plan All‐Cause Readmission 4 PQI11 PQI1 ‐ Diabetes Short‐Term Complication (per 100,000 MY) ¹ 16 16 PQI151 PQI15 ‐ Asthma in Younger Adults (per 100,000 MY) ¹ 16 16 PQI51 PQI5 ‐ COPD or Asthma in Older Adults (per 100,000 MY) ¹ 16 16 PQI81 PQI8 ‐ Congestive Heart Failure (per 100,000 MY) ¹ 16 16 * SBIRT * Alcohol and Drug Misuse (SBIRT) ‐ All Age Groups 10 16 W15 Well Child Visits in First 15 Months of Life 2

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Discussion

Which method seems closest in meeting the original charge from the Metrics & Scoring Committee? Is it more important to measure distribution within a CCO, or across the CCOs?

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Next Steps

• Workgroup will meet twice more to further revise

methods and put together proposal for Metrics & Scoring Committee consideration on April 20th.

• Continue to explore alternate measures to include

in index (not just utilization measures with n>30)

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Next Meeting

Thursday, April 28th 1‐3 pm

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