Metrics Technical Advisory Workgroup September 24, 2015 1 Ag - - PowerPoint PPT Presentation
Metrics Technical Advisory Workgroup September 24, 2015 1 Ag Agenda enda Over Overvi view ew Updates Metrics & Scoring Committee debrief 2016 benchmarks 2016 challenge pool Tobacco measure Committee feedback
September 24, 2015
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Updates Metrics & Scoring Committee debrief
2016 benchmarks 2016 challenge pool
Tobacco measure
Committee feedback Survey results
Food Insecurity Screening measure
Food Rx Program presentation Survey results Draft specifications
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OHA published the 2015 Quality Pool Reference Instructions and initial estimates of the 2015 quality pool by CCO on September 14th. http://www.oregon.gov/oha/analytics/Pages/CCO‐Baseline‐Data.aspx
2014 2015 Size 3% 4% Total QP $128 million (final) $167 million (initial estimate)
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Future enrollment = a child appears on the weekly notification list because their eligibility status has changed in MMIS, but they are not yet enrolled in the CCO as of the weekly report notification date. Children with more than one week lag between notification date and effective enrollment date will be excluded from the measure.
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SBIRT sub‐workgroup is meeting on September 29th. If any other CCOs are interested in the 2016 pilot for testing the EHR‐ based measure specifications, please let us know at metrics.questions@state.or.us. OHA anticipates having the draft EHR‐based measure specifications available for review in October.
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2015 metrics will include both ICD‐9 and ICD‐10 codes. OHA published preliminary ICD‐9 – ICD‐10 crosswalk in July.
Included codes from HEDIS and OHA crosswalk exercises.
OHA will publish final ICD‐10 crosswalk no later than Wed, Sept 30th. Encounters with ICD‐9 coding post Oct 1st will be pended in MMIS; CCOs will be able to correct them to ICD‐10 at that point.
Note all corrections will need to occur by March 31, 2016 for the encounter to meet the submission cut‐off date for incentive measures. Note some TPAs may have their own edit checks to address ICD‐9 codes post October 1st that may need to be resolved prior to any encounters reaching MMIS.
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OHA is currently updating the 2015 incentive measure specifications to include references to the final ICD‐10 codes as well as other updates (e.g., future enrollments for DHS custody). OHA is finalizing the 2016 incentive measure specifications and intends to publish the first batch next week. OHA will notify TAG / CCOs when new and updated specifications are posted online.
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Scheduled for release on Tuesday, September 29th. Updated measurement period: May 2014 – April 2015. Two new slicers!
Chronic conditions Substance use disorders
Supplemental file: CY 2014 ECU with LARC breakout by CCO.
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The Metrics & Scoring Committee met on Friday, September 19th to select the 2016 benchmarks and 2016 challenge pool measures. The Committee selected benchmarks for all but 2 of the incentive measures (see handout).
Colorectal cancer screening Tobacco prevalence
The Committee agreed that the health equity “meta‐measure” concept needed more development prior to adoption for the challenge pool and kept the 2016 challenge pool measures the same as the 2015 measures.
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The Committee agreed that the health equity “meta‐measure” concept needed more development prior to adoption for the challenge pool, but kept it “on‐deck” for 2017. The Committee agreed to keep the 2016 challenge pool measures the same as the 2015 measures:
Alcohol and drug misuse (SBIRT) Depression screening and follow up Developmental screening Diabetes HbA1c
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Co‐meeting with Metrics & Scoring and Hospital Performance Metrics Advisory Committees. Scheduled October 30th from 1 – 4 pm in Wilsonville. Goals:
That the two committees have a shared understanding of issues and work on behavioral health around the state. To begin conversations on a cross‐committee vision for how incentive metrics support this work.
Tentative agenda
Panel presentations followed by joint committee discussion, including:
Lynnea Lindsey‐Pengelly of Trillium (discussing behavioral / physical integration) Chris Farentinos of Legacy Health (discussing Unity Center for Behavioral Health) Robin Henderson of St. Charles Health System
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Committee noted CCOs need to know about OHA’s definition of dental examinations and role of expanded practice dental hygienists. See June 22, 2015 letter from Dr. Bruce Austin providing guidance in the interpretation of the meaning of a “dental examination” and who can provide these exams.
http://www.oregon.gov/oha/healthplan/Announcements/Dental%20examin ations%20under%20the%20OHP%20Recommended%20Periodicity%20Sched ule.pdf
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The Committee: considered the alternate proposal (which would change the minimum cessation benefit requirement from pass / fail to one of three, weighted components); agreed to keep the minimum cessation benefit requirement pass / fail; but asked TAG to consider a way to apply the weighted component concept to the rest of the measure, to phase in the emphasis on reducing prevalence.
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2016 2017 2018
For meeting minimum cessation benefit requirement 40% 60% 33% 66% 25% 75% For reporting EHR‐based prevalence data (meeting population thresholds, etc) 40% 33% 25% For reducing prevalence (meeting benchmark / improvement target) 20% 33% 50%
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At the August meeting, TAG members requested an online survey to provide additional feedback on components of the tobacco measure, including:
Completing the cessation benefit survey in 2015 When the cessation benefit should be in place Recommendations about the 2016 benchmark Whether OHA should require CCOs to submit EHR data in 2015
25 individuals responded, with the majority (88%) representing CCOs.
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11 2 9 2 4 6 8 10 12
Yes No Maybe
N = 22
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7 7 6 1 1 1 2 3 4 5 6 7 8 Very likely Somewhat likely Unlikely Very unlikely Unknown
N = 22
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7 5 5 Prior to the start of the measurement year Sometime during the measurement year After the close of the measurement year
N = 19
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6 6 5 1 during the entire measurement year during the last quarter of the measurement year only during the end of the measurement year only (e.g., last month or day)
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5 4 8 Yes No Maybe
N = 17
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Several CCOs / clinics that already have the ability to report on this measure (or something really close to the measure specifications) can volunteer to pull test data from their EHR and submit to OHA. OHA and CCOs will compare the EHR‐based data with the CAHPS and MBRFSS data on tobacco use. If CAHPS / MBRFSS / EHR‐based data is all fairly comparable, use CAHPS or MBRFSS data (or average of both?) just to set the 2016 improvement target.
CCOs would not have to submit 2015 data from EHRs; this would allow time to develop EHR‐based reporting prior to 2016 submission; Would allow reasonable improvement target setting for the first year of this measure.
If CAHPS / MBRFSS / EHR‐based data is not comparable, we are back where we started re: benchmark / improvement target setting.
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OHA will finalize the cessation benefit survey and the measure specifications in October. Final call for CCO feedback on the draft survey (presented last month) and the measure specifications. Send feedback to metrics.questions@state.or.us by October 7th. Continued discussion (and hopefully decisions) on alternate proposal v2 and benchmark setting at upcoming Metrics & Scoring Committee meeting.
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Food insecurity screening is a topic of interest for the Metrics & Scoring Committee, pending measure development At July TAG meeting, began conversation about food insecurity with presentations from Lynn Knox and Coco Yackley. Began discussion on food insecurity screening measure development. OHA fielded survey after July meeting for CCO feedback on the food insecurity screening measure data source and components. Today:
Presentation from Tom Wunderlich on CareOregon’s Food Rx Program Review survey results and begin discussing draft measure specifications
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11 6 8 5 4 EHRs ‐ data reported electronically EHRs ‐ data reported via chart review Admin (claims) Ideal World Reality (2017)
N = 17
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13 12 11 10 12 10 14 8 6 3 2 7 Did food insecurity screening occur? What were the results of the screening? If 'positive' did follow up occur? What type of follow up was provided? What were the
follow‐up? Prevalence of food insecurity / hunger in a CCO or clinic population? Ideal World Reality (2017)
N = 16
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9 10 11 12 12 12 12 15 How to screen to get the most reliable information Developing community or on‐site programs (e.g., veggie Rx) What are appropriate and effective follow‐up options Provider and/or health plan staff education Developing and implementing new screening workflows Identifying available community and partner resources How to talk sensitively and effectively with patients about food and nutrition issues and resources Building food insecurity screening into an EHR
N = 15
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Primary care providers are being asked to screen for a lot of things and it is hard to complete all screenings and still address member concerns. Providers may not document food insecurity information to protect patient confidentiality, which could be more likely in rural areas. Ideally WIC and other similar organizations would be held accountable for how well they address food insecurity when discovered in clinical settings. How to include dental providers and dental EHRs (given connections between diet and oral health). Difficult and unreasonable to expect CCOs and PCPs to accept accountability for non‐medical issues, such as those traditionally addressed by social service agencies / not reimbursable in Medicaid. Some EHRs may be creating “social determinants of health” packages that could incorporate food insecurity screening, but this will require a lot of work building capabilities into EHRs.
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All patients with at least one eligible encounter during the measurement
All patients ages 12 years and older All patients younger than 12 (will look at whether parents of these children were screened) Questions:
from other efforts?
later)?
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(1) All patients in the denominator who were screened for food insecurity on the date of the encounter or any time during the measurement year, using age‐appropriate, standardized screening questions; and (2) Among those who screened positive for food insecurity, received an intervention or referral to community or health plan resources. Questions:
be able to report on prevalence?
year 1 = numerator 1 only; year 2 = numerator 1 and 2)?
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Please send any feedback on the draft specifications to us at metrics.questions@state.or.us by Friday, October 16th. Future TAG discussion will address what components might need to be in place before the measure could be recommended to the Committee for adoption as an incentive metric (e.g., certain % of EHRs with the capacity to report on food insecurity screening).
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nd 1‐3 pm
Agenda items include:
Save the Date David Labby will give his presentation on the Health Commons Grant (trauma informed care) at the November 19th TAG meeting (1‐3 pm). Interested stakeholders, CCO staff, providers, etc… are welcome to
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