October 26, 2018 1 Agenda Welcome, introductions, meeting goals - - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP

October 26, 2018

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• Welcome, introductions, meeting goals and agenda overview
• Public comment (9:45am)
• Outline of Workgroup Final Report
• Stakeholder input updates
• Measurement strategy: Proposals for consideration and

discussion

• CCO attestation metric: Purpose and possibilities
• Summary and next steps

Agenda

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Public Comment

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Workgroup Final Report Outline

• A. Background on kindergarten readiness, context in Oregon, HAKR

Workgroup formation and charge

• B. Workgroup process and products
• 1. Centering family voice
• 2. HAKR conceptual framework
• 3. HAKR measure criteria
• 4. Gaps and priority areas of interest within conceptual framework
• 5. Identified and assessed developed metrics
• 6. Identified new metrics
• 7. Prioritized metrics (visual of 13 metrics)
• 8. Developed recommendations for Metrics and Scoring Committee

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Workgroup Final Report Outline

• C. Workgroup recommendations (1 of 3)
• 1. The role of the health system is to provide family-centered

services and to work collaboratively with other sectors to ensure children are physically, socially, and emotionally healthy in preparation for kindergarten. The HAKR Technical Workgroup believes that a comprehensive kindergarten readiness plan includes an array of measures to track progress in all domains of kindergarten readiness, alongside sufficient resources and greater capacity for services and system-building.

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Workgroup Final Report Outline

• C. Workgroup recommendations (2 of 3)
• 2. Measurement strategy proposal to Metrics and Scoring

Committee, for inclusion in CCO incentive measure program

• Strategy that includes more than one metric or a metric with

multiple components

• List the specific metric components and proposed timeline

for adoption of various components

• Outline key considerations in identifying a limited set of

metric components in our proposed strategy

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Workgroup Final Report Outline

• C. Workgroup recommendations (3 of 3)
• 3. Targeted recommendations for Health Plan Quality Metrics

Committee, Oregon Health Policy Board, Health Equity Measures Workgroup, Oregon Health Authority, Governor’s Children’s Cabinet, Early Learning Division and others.

• Measure concepts for future development
• Alignment of measurement strategies with recommendations

and work emerging from the Governor’s Children’s Cabinet, CCO 2.0, Early Learning Strategic Plan, and beyond

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Stakeholder Input Received

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Who Has Provided Input

• Metrics and Scoring Committee
• CCO Metrics Technical Advisory Group
• Health Plan Quality Metrics Committee
• Early Learning Hubs
• Primary Care Providers
• Families (in progress)
• Others

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Themes from Stakeholder Input

Caution against recommending a bundled metric with many metric components Excitement about metrics that focus on dental services, mental health services, and follow- up to developmental screening Caution against screening metrics when we know there are challenges with capacity and access to services Focus on the children who are not being served well by the health system now

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Themes from Stakeholder Input

Include at least one metric in set of recommendations that can be implemented in 2020 Summarize evidence and analysis of how recommendations will impact kindergarten readiness Connect recommendations to aligned work underway (CCO 2.0 priorities, CCO- and practice-level QI efforts, etc.)

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Measurement Strategy Proposals: Workgroup Discussion

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How We Will Be Discussing Proposals Today

• Using the metrics visual and overview document as

reference for key information about metrics under consideration

• Using the worksheet to stay focused on our criteria
• Flow for the discussion
• Hear about CCO Attestation Metric concept and example

components

• Discuss 2 staff team proposals
• Open up to additional proposals

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Factors To Use Today For Discussing Proposals for a Multi- Metric Strategy (see worksheet)

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HAKR Workgroup measure criteria if multiple metrics are included: 1. Set of metrics is parsimonious and limited in number of individual components. 2. Includes metrics which, in combination, measure the desired outcome by addressing the array of services that impact a child’s KR. 3. Includes metrics that utilize various data sources. 4. Includes measures with the most transformative potential to drive health system change and stimulate cross-sector collaboration. Additional factors HAKR Workgroup may consider in identifying components:

• Includes a focus on addressing social-emotional health
• Builds momentum for across-sector collaboration and integration within CCOs service lines (physical,

behavioral and dental)

• Set of metrics addresses different populations within 0-5 (e.g. not all metrics for 0-1 vs. 3-6)
• Includes at least one metric that address the full population and a metric that focused on follow-up for

children with specific needs

• Balances urgency and current opportunity with desire for transformation (e.g. includes at least one metric

that can be implemented in 2020)

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How We Developed Staff Team Proposals

• Reflected on priority areas of focus identified in early workgroup

meetings, based on gaps in conceptual framework and family input

• Reviewed assessment scores from when we assessed metrics using
• ur HAKR workgroup measure criteria
• Reflected on deep interest and workgroup discussions on how to

create a focus on social-emotional health and development

• Embedded input we have received from stakeholders
• Given the policy and payment work needed, considered metric

alignment with goals and objectives of CCO 2.0

• Considered gaps in M&S and HPQMC measure sets by domain

and/or service line impacted

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Proposal 1

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Proposal 2

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Workgroup Final Report Outline

Let’s pause to talk about a CCO Attestation Metric (formerly known as Glidepath Metric).

• Purpose is to drive CCOs to address complex system-level factors

that impact the services that kids and families receive and how they receive them, and for which there may be payment or policy barriers that need to be addressed.

• Activities would build capacity within CCOs for enhanced services,

integration of services, cross-sector collaboration, and measurement opportunities.

• Lays the foundation for future child- and/or parent-level metrics.

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8 ) C C O -Le v e l M e tric F o cu se d o n S o cia l-E m o tio n a l H e a lth * (e .g . C C O A tte sta tio n F o rm ).

E xa m p le O p tio n s: A d d re ss p o licie s, p a ym e n ts a n d p ra ctice s fo r : a ) a sse ssin g a ch ild ’s so cia l e m o tio n a l h e a lth a n d fa m ily fa cto rs (in clu d in g SD O H ) im p a ctin g ch ild ’s so cia l-e m o tio n a l h e a lth ; b ) B e h a vio ra l h e a lth se rvice s (in clu d in g in te rn a l to p rim a ry ca re ); c) P a th w a ys to se rvice s fo r ch ild re n id e n tifie d w ith so cia l-e m o tio n a l h e a lth d e la ys .

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Example Components of a CCO Attestation Metric

• Examine and expand practices that address SE health, including family

factors (i.e., SDOH) that impact a child’s SE health: – Convene partners to review and discuss “capacity mapping” findings and regional health complexity data. – Conduct cross-sector training on identifying delays in SE health. – Develop and implement specific pilots meant to address family- centered access of these services. An example could include piloting enhanced assessment of a child’s social emotional health and/or family factors that impact social emotional development, and evaluating whether enhanced assessments result in increased access of behavioral health. For those that access behavioral health, assess the impact on child and family well-being.

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Example Components of a CCO Attestation Metric

• Assess and address capacity of behavioral health services for

children 0-5 and their families, for example: –Map providers, services and capacity for serving children 0-5. –Examine claims data using the behavioral health utilization metric. –Identify pathways for primary care providers who serve children to refer parents identified with depression (i.e., during a well-child visit) to mental health services.

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Example Components of a CCO Attestation Metric

• Examine and address policies and payments for behavioral

health services for children 0-5 and families: –Payment policies that limit access to services. For example, those that limit access to integrated behavioral health services within primary care. –Payments for the assessment of SE delays in children, treatment for perinatal mood disorders in caregivers, or for the assessment of other family factors that impact SE health.

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Workgroup Final Report Outline

What would be the next steps for a CCO Attestation Metric, if included in our proposal to M&S?

• Develop and refine the items that would be included in the metric
• Determine how CCOs would attest to the items
• Determine how many items a CCO must attest to in order to

receive the incentive payment, including whether there are any “must pass” items

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Discussion

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Summary and Next Steps

THANK YOU!

Meeting Schedule November 5, 2018: 10 AM – 1 PM (Wilsonville)

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