Possible Incentive Metrics: Public Health Recommendations Katrina - - PowerPoint PPT Presentation

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Possible Incentive Metrics: Public Health Recommendations Katrina - - PowerPoint PPT Presentation

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Possible Incentive Metrics: Public Health Recommendations Katrina Hedberg, MD, MPH Health Officer & State Epidemiologist April 18, 2014 Context Improve population health, improve care, lower (long-term) costs Address leading

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Possible Incentive Metrics: Public Health Recommendations

Katrina Hedberg, MD, MPH Health Officer & State Epidemiologist

April 18, 2014

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Public Health Division 2

Context

  • Improve population health, improve

care, lower (long-term) costs

  • Address leading causes of death/

illness; health disparities

  • Evidence-based interventions

– In clinic – In community

  • Data exist/ national metrics established
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SLIDE 3

Public Health Division 3

Process

  • Public Health Division medical

epidemiologists/ evaluation experts

  • Content areas: infectious disease, chronic

disease, injury, maternal/ child health

  • Feedback from PHD director, OHA content

experts, the PHD Health Transformation Steering committee

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Public Health Division 4

Population Health Definitions

  • Health Care Delivery (Clinic focus)

– Panel of patients: eligible, enrolled – Patients with specific conditions or utilization

  • Public Health (Community-wide)

– Defined by time, place, person – Indicators are at community level

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Public Health Division 5

More Public Health Terms

  • Data Sources:

– Vital Records (birth, death) – Health Surveys (BRFSS, OHT) – ALERT (immunization registry

  • National guidelines

– Healthy People 2020 – Preventive Services Task Force (Community Guide, Guide to Clinical Preventive Services)

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Public Health Division 6

Incentive Metrics

  • Tobacco Use
  • Obesity
  • Teen Pregnancy
  • Influenza Vaccination
  • HPV Vaccination
  • HIV screening
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Public Health Division 7

Incentive Metrics

  • Tobacco Use
  • Obesity
  • Teen Pregnancy
  • Influenza Vaccination
  • HPV Vaccination
  • HIV screening
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Public Health Division 8

Behaviors that Kill Oregonians

7000 1500 1400

Tobacco Obesity Alcohol

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Public Health Division 9

Tobacco Use Prevalence

  • Metric: Percent CCO enrollees >18 years
  • f age who report smoking
  • Data source: BRFSS; CAHPS
  • Benchmark:

– HP2020--12% smoking prevalence in adults; – 1115 Medicaid waiver– 25% adult smoking prevalence

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Public Health Division 10

Cigarette smoking prevalence

0% 5% 10% 15% 20% 25% 30%

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Adults 8th Graders

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Public Health Division 11

Cigarette Use by Insurance Oregon, 2012

5 10 15 20 25 30 35 40 Medicaid Other Insurance

13%

percent

Range: 23%-42%

36%

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Public Health Division 12

Rationale

  • Medicaid patients >2.5 times more likely

to smoke

  • Smoking costs Oregon:

– $1.3 Billion overall in medical costs – $374 Million for Medicaid medical costs

  • Cessation is evidence-based according

to US Preventive Services Task Force

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Public Health Division 13

Operationalization

  • Assess smoking status
  • Advise to quit
  • Evidence-based smoking

cessation Rx

  • Tobacco-free campuses
  • Partner with LHD tobacco

control

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Public Health Division 14

Community Tobacco Control

  • Limit access
  • Vending machines
  • Placement of cigarettes
  • Increase price
  • Smoke-free Air Policies
  • Media
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Public Health Division 15

Obesity Prevalence

  • Metric: Percent of CCO enrollees >18

years with a Body Mass Index > 30 based on measured height and weight

  • Data source: BRFSS; CAHPS
  • Benchmark:

– HP 2020– 30% obesity in adults

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Public Health Division 16

Obesity in Oregon Adults and 8th Graders

Source: Oregon BRFSS and Oregon Healthy Teens Survey

0.0 5.0 10.0 15.0 20.0 25.0 30.0

Percent Adults 8th Graders

New BRFSS weighting method began in 2010.

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Public Health Division 17

Oregon Diabetes Prevalence

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0%

Percent Oregon US

New BRFSS weighting method began in 2010.

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Public Health Division 18

Obesity by Insurance Oregon, 2012

5 10 15 20 25 30 35 40 45 Medicaid Other Insurance

26%

percent

40%

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Public Health Division 19

Rationale

  • Medicaid patients >1.5 times more likely

to be obese

  • Medical costs:

– $1.6 Billion for medical care overall – $333 Million for Medicaid medical care

  • Premature deaths: 1,400 Oregonians/ yr
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Public Health Division 20

Operationalization: MPOWER

  • Monitor: obesity, chronic dz, exercise, diet
  • Promote: healthy eating/ active living
  • Offer: evidence-based support (e.g. weight

watchers)

  • Warn: dangers of fats, sugar-sweet drinks
  • Enforce: laws (e.g. breast-feeding space)
  • Raise: price of unhealthful foods
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Public Health Division

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Public Health Division 22

Community Healthy Diet Policies

  • Access

– Vending machines (work / school)

  • Availability of choice

– Restaurant / store locations / farmers’ markets

  • Public Education

– Menu labeling

  • Cost

– Tax sugar-sweetened beverages / fast food – Price incentives / subsidies for healthy foods

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Public Health Division 23

Teen Births

  • Metric: Rate of pregnancy in CCO

enrolled females 15-17 years

  • Data source: MMIS
  • Benchmark:

– HP 2020– 36.2 per 1,000 teens

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Teen Pregnancy (15-17 yrs)

5 10 15 20 25 30 35 Rate per 1,000 females age 15–17 years

Oregon Birth Certificate Data; Induced Termination of Pregnancy Database Source:

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Teen Pregnancy Rates by Race / Ethnicity, 2010

0.00 10.00 20.00 30.00 40.00 50.00

Pregnancy Rate Birth Rate Pregnancy per 1,000 Females

Non-Latino White Non-Latino African American Hispanic/Latino

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Public Health Division 26

Rationale

  • Teen pregnancy linked to:

– Poverty, high school completion, child/ family well-being

  • Disparity, particularly in Hispanic and

African American teens

  • Lower teen pregnancy lower health

care costs

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Public Health Division 27

Operationalization

  • Assess reproductive health needs at

adolescent well-child visit

  • Work with LHDs on teen pregnancy

prevention

  • Support school-based health centers
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Public Health Division 28

Influenza Immunization

  • Metric: Percent of CCO enrolled patients

6 months - 64 years who received annual flu shot

  • Data source: MMIS; ALERT
  • Benchmark:

– HP 2020– 80% for non-high risk; 90% for high risk

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Public Health Division 29

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Public Health Division 30

Influenza Immunization

  • Current data:

–CAHPS: 58.5% of adults 50-64 yrs –BRFSS 29.7% of adults18-64 years

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0% 10% 20% 30% 40% 50% 60% 70% 80%

Source: Oregon Immunization Program, Oregon Health Authority

Influenza Immunization Rates,

Oregon 2013-2014

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Public Health Division 32

Rationale

  • 10%-20% population infected annually
  • US:

– Hospitalizations: 55,000-430,000/ year – Deaths: 3,000-49,000/ year

  • Complications: <2 years and >65 years;

chronic disease, pregnancy

  • School-aged kids spread infection
  • Vaccine: 73% effective
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Public Health Division 33

Operationalization

  • Offer flu vaccine to everyone 6 mo-65

yrs in the fall

– Standing orders – Computerized reminders – Feedback to providers – Telephone reminders to patients – Expanding clinic hours/ locations

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Public Health Division 34

HPV Immunization

  • Metric: Percent of CCO enrolled females

age 13 years who have received 3 doses

  • f HPV vaccine
  • Data source: MMIS; ALERT
  • Benchmark:

– HP 2020– 80% of females 13-17 years have received 3 doses of HPV vaccine

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Public Health Division 35

HPV Immunization

  • Current data:

– 33% of Oregon females 13-17 years have received 3 doses

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Public Health Division 36

Rationale

  • Most common STD in US: 6.2 million

new infections annually

  • Major cause of cervical dysplasia and

cancer: annually 3500 cases of high- grade dysplasia in Oregon women 21- 29 yrs

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Public Health Division 37

Operationalization

  • Education of parents
  • Assess HPV vaccination status during

adolescent visits

  • Reminder notices through ALERT
  • Provider-based vaccination coverage

assessment by Immunization Program

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Public Health Division 38

HIV Screening

  • Metric: Percent of CCO enrollees 15-65

years with documentation of HIV screening ever

  • Data source: MMIS
  • Benchmark:

– HP 2020– 18.9% of persons aged 15-44 yrs with HIV screening annually

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HIV Screening by Race/ Ethnicity:

Oregon, 18-64 year olds

10 20 30 40 50 60 70 White Afric Amer Asian PI Amer Indian Latino

percent

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Public Health Division 40

HIV Screening

  • Current data:

– 37.5% of Oregon adults 18-64 years report having ever been screened

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Public Health Division 41

Rationale

  • 5,500 Oregonians are known HIV+; 250

new diagnoses annually

  • 500-1000 people unaware HIV+; source

for 50%-70% new infections

  • 30%-40% of HIV+ diagnosed late stage
  • CDC; US Preventive Svc Task Force

recommend universal HIV screening

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Public Health Division 42

Operationalization

  • Patient reminders for screenings
  • EHR reminders for HIV screening and

documentation

  • Routinize HIV screening as part of

medical care

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Questions?

Public Health Division