Metrics Technical Advisory Workgroup May 25, 2017 PLEASE DO NOT PUT YOUR PHONE ON HOLD – IT IS BETTER IF YOU DROP OFF THE CALL AND REJOIN IF NEEDED
Today’s Agenda • Updates • SBIRT EHR-based measure workgroup update • TAG 2018 recommendations to Metrics & Scoring • (jumping to ECU)
Effective Contraceptive Use • Exclude same-sex partners, sterility, gender orientation and pregnancy intentions • This would require moving to an EHR-based measure • Many of these visits occur with public health rather than primary care. TAG expressed concern about public health’s ability to document these situations in an EHR. • It would be preferable to capture these situations in benchmark and target setting. TAG members feel that the current benchmark is too high and should be reviewed. • TAG does not recommend modifying the measure specs in this way, but rather adjusting the benchmark and/or target methodology.
Effective Contraceptive Use • Add codes for unspecified contraception • Measure whether patient is offered contraceptives/contraceptive counseling, rather than contraceptive use • Move from claims-based to EHR-based measure (stop using surveillance codes) • The TAG expressed a desire to better understand the intent of this measure before making a recommendation on potential modifications.
The intent of this measure • 1. Providing high quality primary care for women by improving contraception access • Women are fertile for about 40 years, on average they are trying to avoid pregnancy for 35 of them • 99% of sexually active women use contraception at some point in their lives • Contraception is the most commonly needed primary care service for women (along with dental care!) • At least 70% of women age 18-50 need contraception, only 36% of those on Medicaid got it in 2015 • 2. Preventing unintended pregnancy • Having an unintended pregnancy means a woman is three times more likely to end up below the poverty line 2 years later • Unintended pregnancies can derail education and job options, relationships and are associated with worse maternal and infant outcomes https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states https://www.ansirh.org/research/turnaway-study https://www.nap.edu/catalog/4903/the-best-intentions-unintended-pregnancy-and-the-well-being-of
Is this metric meeting our intent? • Yes, in that it focuses on the measureable outcome of contraception claims. • Primary outcome for our first intent (more contraception access) • Intermediary outcome for our second intent (unintended pregnancy) • Shortcomings in the specifications • We cannot reliably exclude from the denominator women who do not need contraception (trying to get pregnant, not having sex with men) • We cannot count vasectomies as they are claims on someone else’s chart • Lookback for hysterectomy and tubal is 7 years within Medicaid • Surveillance codes required for multiyear methods • We account for the unfixable shortcomings in specifications by lowering the benchmark • A “perfect score” is 70%, not 100%
Updates
CCO Metrics Dashboards • CY 2016 dashboard released April 28 • May 10 release • Child immunization status • Immunization for adolescents • Postpartum care • May 18 release • CAHPS – Access to care; Satisfaction with care • Prenatal care (revised) • Effective contraceptive use (revised) • Colorectal cancer screening
CCO Metrics Dashboards • Next Steps • CCO validation questions due May 31 • Final CY 2016 results (dashboards) distributed June 22 • Public CCO Metrics Report released June 27 • Quality pool (including challenge pool) dollars distributed by June 30
Rebase policy for EHR-based measures • Metrics TAG asked whether OHA would rebase improvement targets if a CCO started to report CCO Medicaid only data • Answer: Yes, if the CCO can submit data to support the rebase calculation and the CCO is switching all of its reporting to CCO Medicaid only • If a CCO requested a rebase for its 2018 improvement targets, for example, it would have to submit a rebase report of 2017 data that was limited to CCO Medicaid only • The rebase data would be due later in the year than the CCO data submission used for performance calculation • A CCO could not request rebasing until all of its reporting clinics can report CCO Medicaid only
Transformation Center Technical Assistance • CCO needs assessment calls covering the new metric: Emergency department utilization for individuals experiencing severe and persistent mental illness • Tuesday, May 30, 10-11 a.m. OR Friday, June 2, noon-1 p.m. • 866-390-1828; participant code: 4628003 • Tobacco Cessation Webinars: • Tobacco Cessation Clinical Workflow • When: July 18, 1-2:30 p.m. • Register here: https://attendee.gotowebinar.com/register/1587067351965435394 • Mobile Health Behavioral Intervention Platforms for Smoking Cessation • When: June 13, 9:30-10:30 a.m. • Register here: https://attendee.gotowebinar.com/register/641296036523653635 • Questions? Contact Anona Gund at anona.e.gund@state.or.us. • Effective Contraceptive Use among Women at Risk of Unintended Pregnancy • Webinar series: Clinic-level strategies to increase effective contraceptive use • When: May 31, June 7, June 15, June 22, June 29 • See handout for more information, including exact times and the links to register. • Webinar - Immediate Postpartum LARCs: Billing and Coding • When: Thursday, June 1, 1-1:45 p.m. • Register here: https://attendee.gotowebinar.com/register/4815094952765841921 Questions? Contact Adrienne Mullock at adrienne.p.mullock@state.or.us . • TRANSFORMATION CENTER 11 Health Policy & Analytics Division
Hospital Transformation Performance Program • Payment for Year 3 / 2016 will be distributed in June (report to be published 13 June) • Hospital Performance Metrics Advisory Committee will next meet on July 31 st .
Metrics & Scoring Committee • Met last Friday, 19 May • Heard presentations on and discussed the effective contraceptive use measure, kindergarten readiness, and SBIRT • Draft ‘long list’ of metrics (informal, for discussion only) included in packets • Next meeting is Friday, 16 June • Hear TAG’s recommendations regarding 2018 measures • Select 2018 measures • Benchmarking discussions will begin in July
SBIRT Update
CCO SBIRT Measure Metrics & Scoring Committee approved in concept, subject to pilot testing and implementation decisions Initial Patient Population (IPP) = All patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period Rate 1: Screening D1 = IPP N1 = Patients who received an age-appropriate screening, using an SBIRT screening tool approved by OHA, during the measurement period, and had either a brief screen with a negative result or a full screen Rate 2: Brief intervention and referral D2 = Patients in IPP who had a positive full screen during the measurement period N2 = Patients who received a brief intervention, a referral to treatment, or both within 2 months of a positive full screen
Exclusions and Exceptions • Numerator exclusion: SBIRT services in ED or hospital setting • Denominator exceptions* • Patient refuses • Emergent situation • Patient functional capacity or motivation * These are the same denominator exceptions as depression screening and follow-up measure, but intention is to allow for data capture in a queryable field, not just in SNOMED codes
Denominator Exclusions • Active diagnosis of alcohol or drug dependency • Engagement in treatment • Dementia or mental degeneration • Limited life expectancy • Palliative care (includes comfort care and hospice)
Implementation Considerations • Need volunteers to pilot the measure – please email metrics.questions@state.or.us by June 9 • Questions to consider for further discussion in June: • Unintended consequences of shortening measurement period for first year to start July 1, 2018? • Feedback to Metrics & Scoring Committee about how to approach setting a first year benchmark?
Review: TAG Measure Modification Recommendations
Bundled Measures (1-4) • Bundled metrics generally add unnecessary complexity and do not save work in terms of data and reporting. • TAG does not recommend any of the proposed bundled measures for implementation in 2018.
Adolescent Well Care Visits • Change upper age limit to 18 • Up to age 21 is pediatric scope of practice. We don’t want to drop a group of people (age 19-21) that need help. • Many CCOs take a different approach to AWC for age 12- 18 vs 19-21. Members also begin to fall into different rate groups as they get older. • The TAG does not support this modification.
Adolescent Well Care Visits • Exclude sports physicals • Sports physicals are a way for providers to engage and teach. If the intent of AWC measure is to establish healthy behaviors, sports physicals accomplish that. • HEDIS includes sports physicals. Since sports physicals alone make up such a small percentage of AWC numerator hits, we do not want to deviate from HEDIS. • The Transformation Center is working with OSAA to better understand the difference in well care visits and sports physicals. • The TAG does not support the modification to exclude sports physicals at this time. The TAG wants to keep informed of the work of the Transformation Center and OSAA around this issue.
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