Metrics Technical Advisory Workgroup June 22, 2017 PLEASE DO NOT - - PowerPoint PPT Presentation
Metrics Technical Advisory Workgroup June 22, 2017 PLEASE DO NOT PUT YOUR PHONE ON HOLD IT IS BETTER IF YOU DROP OFF THE CALL AND REJOIN IF NEEDED 1 Todays Agenda Updates Benchmarking Model TAG July M&S Recommendations
June 22, 2017
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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TC/Resources/Culturally%20Specific%20Tobacco%20Cessation%20Resources%20for%20Patients.docx
language and reproductive health
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today!
Dashboard distribution list
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Measures Reporting Guidance Documentation, with opportunity for comments before finalizing
come next month
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2016 threshold 2017 projected 2017 revised Diabetes HbA1c poor control 65% 75% 70% Controlling high blood pressure 65% 75% 70% Depression screening and follow-up 65% 75% 70% Smoking prevalence 25% 50% 30%
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available for 2017 reporting
submissions in advance of 2018 reporting deadlines
2016 for data proposals and aggregated data submissions
submission of QRDA I report
measures only: diabetes HbA1c poor control, controlling high blood pressure, and depression screening and follow-up
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quality programs for each measure year
to accept older versions of the CMS measure specs (e.g., CMS 122v4)
use updated versions for reporting – timing?
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slides)
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bundled oral health measure related to diabetes for possible inclusion in the ‘on deck’ list for 2019 to be presented to the Health Plan Quality Metrics Committee (HPQMC).
inclusion in future years.
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population measure - numerator counts for physical health issues only, per HEDIS).
distinct measures).
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for adult and child measures; must hit benchmark/target for both to qualify for measure)
kindergarten readiness; Committee will identify specific measures in July.
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Obesity
At its May meeting the Committee asked staff to present any obesity metrics which would be ready to implement in 2018. Staff found two such measures from the meaningful use measure set:
(https://ecqi.healthit.gov/ep/ecqms-2018-performance- period/preventive-care-and-screening-body-mass-index-bmi-screening- and)
children & adolescents (https://ecqi.healthit.gov/ep/ecqms-2018- performance-period/weight-assessment-and-counseling-nutrition-and- physical-activity)
to the long list of possible 2018 measures upon which the Committee would vote to identify the 2018 measure set.
to the “on deck” list for 2019 to be presented to the HPQMC.
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Committee has decided not to include SBIRT in the 2018 CCO incentive measure set
email metrics.questions@state.or.us
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(overleaf) in the 2018 measure set
until July, to allow additional time for reflection and discussion (the Committee called out Follow-up after hospitalization for mental illness, specifically)
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No Measure Votes 1 Child obesity - BMI, nutrition and activity counseling* 8 2 Diabetes HbA1c control* 8 3 ED utilization - general pop* 8 4 Smoking prevalence* 8 5 Childhood immunizations* 7 6 Colorectal cancer screening* 7 7 Dental sealants for children* 7 8 Developmental screening* 7 9 Equity measure - ED utilization amongst SPMI pop* 7 10 Assessments for children in foster care (physical, mental, dental)* 6 11 CAHPS - access to care (bundled)* 6 12 Controlling high blood pressure* 6 13 Depression screening* 6 14 Effective contraceptive use* 6 15 PCPCH* 6 16 Timely prenatal care* 6 17 Adolescent well-care visits* 5 18 Follow-up after hospitalization for mental illness 4 19 Preventive dental utilization for adults 3 20 CAHPS – satisfaction 2 21 CAHPS - shared decision-making
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testimony calling attention to the fact that a CCO can be a top performer on a measure, yet still not qualify for payment if improvement from the previous year was negligible or went slightly backward. This will likely become more common as the program matures and initial large gains give way more steady high
are essentially penalized in later years.\
to consider possible modifications for the 2018 measurement year and beyond.
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benchmarking structures in other states (Massachusetts, Maryland, Washington, Iowa) and discussed options.
previous slide, as performance overall still quite low.
model: Recognition of both excellence and improvement.
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targets. Pros:
that is still substantial improvement overall, should be rewarded.
population health measures, adolescent well-care visits(?)
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a few more points in year 2?
measure (see example)
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simply stipulate that top performer achieves measure
removing or lowering improvement target floor
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include permanent numerator credit for tubal ligation
account for tubal ligations, but wanted to see additional data before deciding on whether to:
(a) modify the lookback period to give permanent numerator credit for tubal ligations ever previously received or (b) exclude woman who have had tubal ligation from the denominator (credit would be given in year tubal conducted; member would be excluded in subsequent measurement periods)
(see summary data on next two slides)
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ECU 2016 FEMALE STERILIZATION CATEGORY CODES COUNT OF DISTINCT MEMBERS WITH CODE 2011 2012 2013 2014 2015 2016 58340 Catheter for hysterography 282 283 244 563 565 439 58565 Hysteroscopy sterilization 198 154 148 241 233 60 58600 Division of fallopian tube 26 31 25 40 29 15 58605 Division of fallopian tube 761 638 628 741 764 598 58611 Ligate oviduct(s) add-on 1,086 1,086 1,151 1,298 1,305 1,181 58615 Occlude fallopian tube(s) 16 16 24 19 22 11 58670 Laparoscopy tubal cautery 376 410 471 616 714 637 58671 Laparoscopy tubal block 353 342 327 380 375 322 74740 X-ray female genital tract 155 165 124 247 260 179 A4264 Intratubal occlusion device 11 18 73 108 134 75 662x Bilateral endoscopic destruction or occlusion of fallopian tubes 20 22 32 37 32 0U574ZZ Destruction of Bilateral Fallopian Tubes, Perc Endo Approach 2 5 0UL74CZ Occlusion Bi Fallopian Tube w Extralum Dev, Perc Endo 1 4 0UL74DZ Occlusion Bi Fallopian Tube w Intralum Dev, Perc Endo 1 0UL74ZZ Occlusion of Bilateral Fallopian Tubes, Perc Endo Approach 14 13 0UL78ZZ Occlusion of Bilateral Fallopian Tubes, Endo 1 V252 Sterilization 3,636 3,464 3,616 5,138 4,498 V2651 Tubal ligation status 648 603 772 1,827 3,032 Z302 Encounter for sterilization 1,493 4,920 Z9851 Tubal ligation status 1,402 5,603 Distinct members with ANY female sterilization code 4,290 4,082 4,213 5,997 8,409 9,991 Percent change compared to prior year
3% 42% 40% 19%
Current 2016 ECU specs (age 18-50) Scenario A: keep tubal in numerator permanently Scenario B: numerator hit in year, then permanent exclusion in subsequent years 2015 N D R N D R Comparison with current specs N D R Comparison with current specs delta N delta D delta R delta N delta D delta R statewide 45,211 124,722 36.2%49,274 124,722 39.5% 9% 0% 3.3% 42,328 112,979 37.5%
1.2% 2016 N D R delta N delta D delta R N D R delta N delta D delta R statewide 42,704 107,841 39.6%46,959 107,841 43.5% 10% 0% 3.9% 43,294 101,374 42.7% 1%
3.1% Change 2015-> 2016
3.3% -2,315 -16,881 4.0% 966 -11,605 5.2% Percent change 2015 -> 2016
9.2%
10.2% 2%
14.0%
recommendations are as follows
included in CCOs by default in 2018, and the differing thresholds for this population in the HEDIS specifications versus the CMS specifications (used for the CCO metric), TAG recommends the Committee lower the benchmark for 2018 (2017 is at national Medicaid 90th percentile, 69.0%).
amending benchmark
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MONTH AGENDA July
benchmark decisions made
measure set (M&S will make recommendations to the HPQMC August Cancel or office hour? Sept
development work
specifications (subject to availability of Helen Bellanca)
development at state level (may be premature) Oct Cancel or office hour? Nov TBD Dec Cancel?
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Next meeting: July 27, 2017, 1-3 pm
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