Performance Measurement & Member Engagement June Meeting June - - PowerPoint PPT Presentation

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Performance Measurement & Member Engagement June Meeting June - - PowerPoint PPT Presentation

Dec 03, 2022 27 likes •209 views

Performance Measurement & Member Engagement June Meeting June 25, 2020 1 Agenda 3:00 3:10 Roll call and approval of Mays minutes 3:10 3:15 Discuss/vote on July meeting and purpose 3:15 3:45 Wrap up the APM COVID measure

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Performance Measurement & Member Engagement

June Meeting

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June 25, 2020

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3:00 – 3:10 Roll call and approval of May’s minutes 3:10 – 3:15 Discuss/vote on July meeting and purpose 3:15 – 3:45 Wrap up the APM COVID measure discussion 3:45 – 4:25 Brainstorm how to improve the prenatal KPI 4:25 – 4:30 Next steps

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Agenda

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Roll Call & Meeting Minutes

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Potential Agenda If We Meet:

  • Scope of work: Develop topics to cover for next 6-12
  • mos. and how to be most impactful time-wise
  • Recommendation process
  • Discuss onboarding new Medicaid members in August

Vote?

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July: To Meet or Go on “Vacation”?

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APM Wrap Up

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Three COVID measures were proposed: (1) Participation in clinical trials (2) Provider engagement and outreach with high risk members (3) Telemedicine utilization

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APM Summary from Last Time

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In May, we talked about the following:

  • Should it be a structural measure or a clinical measure?
  • Any measure created should circumvent the changing

nature of the pandemic

  • Audio is very important in addition to video telemed
  • Measure what matters to members (ease of access for

some, safer during pandemic, follow up’s for medications)

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APM: Telemed COVID Measure

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  • Providers must already be collecting and reporting this
  • data. We can’t ask for new information from providers.
  • What problem do we want to narrow in on? (e.g.,

decline in no show rates, decline in ED utilization, utilization among members with barriers)

  • Do we want one quantitative measure or several types
  • f qualitative data? (structural measure)?
  • Other questions or ideas?

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APM: Telemed COVID Measure

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Prenatal KPI

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Prenatal KPI: Definition

  • Percentage of members with at least
  • ne prenatal visit in the 40 weeks

prior to delivery out of all live birth deliveries that performance period (which is a rolling 12-months).

  • Members must be enrolled in Medicaid

at least 30 days before delivery

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  • To start identifying an improved methodology for

calculating the Prenatal Engagement KPI.

  • We do NOT have to finalize anything today.
  • What’s the on the table? Both small adjustments or

even large changes to this measure.

  • Ideas gathered today and in the following weeks will be

presented to the RAEs for feedback.

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Prenatal KPI: Today’s Objective

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  • Most services that pregnant women and new mothers

receive are difficult to measure because they are “bundled” and reimbursed globally, meaning a doctor receives one rate for all services provided.

  • As a result, the Department doesn’t get a bill with line

items for the specific services received.

  • In short: We can’t track visits or specific actions like

assessments that providers administered using claims data.

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Prenatal KPI: The Challenge

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  • Complications of pregnancy
  • Depression screens for pregnant and post-partum women
  • Lab tests
  • Prenatal testing (e.g., ultrasounds)
  • Initial antepartum visit

A more detailed list can be found here.

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Prenatal KPI: Outside the Bundle

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  • The current KPI does not clearly indicate when prenatal

visits happened

  • It doesn’t adjust for high-risk pregnancies. One prenatal

visit isn’t adequate especially for women with more risk factors.

  • Women who sign up for Medicaid when delivering aren’t

included, if we wanted to capture any type of broader perinatal care

  • Prenatal visits are still a measure of access not health
  • utcomes – what is our ultimate goal?

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Prenatal KPI: Less Than Perfect

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  • Performance pool: Premature Birth Rate (< 37 weeks)
  • CMS Core Measures: Low birth weight (< 2500 grams,

NQF 1382)

  • Maternity bundled payment pilot: Measures are in

development now

  • Maternity programming: 5 components

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Prenatal KPI: Related Measures

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  • What outcomes matter most to members in terms of

prenatal and perinatal care?

  • After deciding what we should measure, how can we

measure it?

  • What data sources are available?
  • What are the advantages/disadvantages?
  • What are questions or ideas do you have to adjust or

change this measure?

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Prenatal KPI: Discussion

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Feasible Maybe Not Feasible HEDIS Measures WIC/SNAP Data Labs ADT Hospital Data eCQMs Potentially Avoidable Maternal Complications PRAMS / survey data Depression screens Maternal morbidity NEMT Other ideas?

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Prenatal KPI: Ideas

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Next Steps