September 11th, 2018 1 Agenda Welcome, introductions, meeting - - PowerPoint PPT Presentation
HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP September 11th, 2018 1 Agenda Welcome, introductions, meeting goals and agenda overview Where weve been and where were going: Progress and products Measurement
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March – September 2018
measure program
and the OKA
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HAKR Final Report Conceptual Framework, Measure Criteria, Areas of Priority, Proposal to M&S, Areas for New Measure Development, Recommendations to HPQM, OHPB, Health Equity Measures Workgroup, HERC, etc.
Recommendations to Health Plan Quality Metrics Committee (HPQM)
proposed for Metrics and Scoring adoption (required)
used by M&S and potentially other plans (PEBB, OEBB) Example: Consider inclusion of all metrics HAKR workgroup rated highly. If on HPQMC list, would add weight for use by others (e.g. for VBP, contracting, etc.) Current measure list N=51
Proposal to Metrics and Scoring (M&S)
strategy
various components Current set N=19
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Required Criteria – Reportable at the CCO level – Annual Reporting Criteria Considered Technical Measure Criteria – Evidence‐based and scientifically acceptable – Has a relevant benchmark – Not greatly influenced by patient case mix Program‐Specific Criteria – Consistent with goals of program and CCOs – Useable and relevant – Feasible to collect – Promotes increased value – Present an opportunity for quality improvement – Transformative potential – Sufficient denominator size Criteria Considered for the Measurement Set – Representative of array of services provided by program – Representative of diversity of patients served by program – Not unreasonably burdensome to payers or providers
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Significant Changes for 2019 Future Expansions Already Planned – 2020: Significant changes to two measures: 1. Health assessments for children in foster care and 2. Dental sealants measure – 2021: Significant changes to two measures: 1. Depression screening and 2. Postpartum care Potential Additional Changes – 2020: Measure(s) focused on increasing health equity – 2021+: Obesity measure – Future: Other developmental areas (food insecurity or SDOH screening, etc).
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Given Metrics and Scoring (M&S) has a limited number of “seats” AND the measure list was increased for 2019 AND there are a number of other metrics being proposed, we will:
that are feasible to adopt in the context of the total number of metrics on the list
M&S measurement set and therefore may have a higher likelihood of adoption
leveraging current level of support
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Measurement Strategy is Like a Puzzle: Metrics are “Pieces” & Strategy is How They Fit in the Larger Puzzle and the Picture Created
How Does it Fit in the Larger M&S Puzzle?
feasible to put in the set?
the pieces meaningfully address HAKR, fill gaps in M&S set, and highlight most transformative areas?
2020 M&S Measure Set 2021 M&S Measure Set 2022 (+) M&S Measure Set Is it feasible to develop these pieces? Is it feasible to get HPQM adoption of metrics for M&S use? In what year(s) is it feasible to add the piece, given space in M&S set and what is addressed in the set?
OR
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Options
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Factors for considering an individual metric as a component of the strategy
– HAKR measure criteria score (Workgroup assessment) – Fills gap in HAKR conceptual framework – Builds off input heard in discussions around new metrics, importance of focus on social‐emotional health – Fills gap in domains covered in the M&S measurement set – Fills gap in metrics for specific CCO services lines in the M&S measurement set – Level of development and resources needed (for Near Ready Metrics) – Likelihood of adoption by Health Plan Quality Metrics
Factors for considering the “set of individual metrics”
– Includes a focus on addressing social‐emotional health – HAKR Workgroup composite measure criteria: 1. Composite metric 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.
In order to be successful, our measurement strategy should include: A feasible total number of metrics A staggered roll out, given inclusion of multiple metrics An approach that makes it desirable for CCOs to adopt and focus on the topic
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Current CCO Incentive Metrics, “Ready” Metrics, “Near Ready” Metrics (With Mean HAKR Criteria Scores for Metrics Assessed)
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Current CCO Incentive Metrics: Population and Service Lines Addressed and Gaps
2019 CCO Incentive Measures Population Prenatal Children Adults
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X X
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(EHR) Teens X
X
X
members with Mental Illness X
to treatment (SBIRT) Teens X
Teens X
X
X X
X
counseling in children and adolescents X TOTAL 1 12 12 CCO Service Line Physical‐ Prevention, Screening Physical – Follow‐up Service Provided Physical‐ Acute Care Setting Behavioral Dental X X X X X X X X X X X X X X X 12 1 2 X X X X 2 2
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Highlighting Social-Emotional Health: Opportunities and Challenges
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Opportunities
wouldn’t be captured in a claims‐based measure Challenges
metric that could be: – Reviewed and approved by HPQMC – Reviewed and approved by M&S Opportunities
steps for moving forward, including HERC examination of evidence on social‐emotional screening
Mental Health Utilization: Clarification on Metric, Services for Children with Social-Emotional Delays or Disorders
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Intent of the revised metric and the development work needed to make it “ready” is to address services discussed in many HAKR workgroup meetings and to address gaps in follow‐up domain: – Dyadic therapies for children and their parents that address attachment, social‐emotional health, and build resilience – Dyadic therapies to address behaviors in children exposed to adverse childhood events
Psychotherapy and Parent Child Interaction Therapy (included in metric) as one of her first steps after starting ACES screening. – Includes claims that, in concept, could be used by internal behavioral health AND by specialty mental health
– Assessments included are not screens, but robust assessments that often allow providers to examine family and social determinants that may be driving social‐emotional delays
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children 0‐5 to address those children with greatest needs and for whom schools are asking for help
children identified – MH Utilization metric focuses on use of resources for those children with significant social‐emotional delays – Complements and supports future social‐emotional screening by creating a focus
rather than an outcome metric
Mental Health Utilization: Clarification on Metric, Services for Children with Social-Emotional Delays or Disorders
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Options
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Input Needed Related to Options for Ready Metrics
Options Considering: A2) New Oral Health Metric
CCOs for this age‐group; dental metric highest HAKR score
and it could be argued it is a two‐part metric A3) Well‐Child Visits 3‐6
in well‐visit, inc. focus on SE
M&S measure set already has metrics in this HAKR domain Proposing to Not Include These Options: A1) Two metrics added to M&S likely to jeopardize B and C Options given total number in M&S set A4) Opportunity to add focus on oral health without adding a metric
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Input Needed Related to Options for Near Ready Metrics: Part 1
C1) Follow‐Up to Developmental Screening
C2) Maternal Depression Screening in Child’s Visit
development
conceptual domain for which there are other metrics C3) Mental Health Utilization
within behavioral health)
workforce and capacity in state; depending on codes included, could create a focus on assessments and not services
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Input Needed Related to Options for Near Ready Metrics: Part 2
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Options Considering C4) Expand Existing CCO Metrics
– Practices who are caring for children in the first year of life have already (in concept) been focusing on this metric given other populations:
B2) instead of C3) Include MH Utilization in the Glidepath Metric
services and policies to support kids with social‐emotional delays – Will stimulate policies and payment related to internal behavioral health – Glidepath metric could also include items related to SE screening (a way to get more children identified and into those services)
Input on Factors Used to Design the Measurement Strategy and the Set of Recommended Metrics
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Factors to Use to Assess the “Set of Individual Metrics” Included In the Measurement Strategy – Does the set include a focus on addressing social‐emotional health? – Does the set meet the HAKR Workgroup “Composite” Measure Criteria? 1. The 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. – Does the set include a feasible total number of metric and a feasible staggered roll out so that it does not significantly increase the M&S measure list? – Is the set of metrics feasible to develop? Are there other factors we should consider?
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HAKR Final Report Conceptual Framework, Measure Criteria, Areas of Priority, Proposal to M&S, Areas for New Measure Development, Recommendations to HPQM, OHPB, Health Equity Measures Workgroup, HERC, etc.
Recommendations to Health Plan Quality Metrics Committee (HPQM) Proposal to Metrics and Scoring (M&S)
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– Various domains that health care impacts – In ideal world, a comprehensive set of metrics would address each domain within the conceptual framework
– Health Plan Quality Metrics – Oregon Health Policy Board – Health Equity Measures Workgroup
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Specific Recommendations Noted During Review of Near Ready Metrics
– Make a recommendation to HPQM that:
focused on CYSHN.
CYSHCN. – Examine options for stratifying the metrics identified by CYSHN.
Equity Measures Workgroup about the importance of addressing disparities in birth outcomes and developmental origins of health and disease.
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New Recommendations Proposing Based on the 8/27/18 Discussion on New Metrics
– Summary of key themes in Bright Futures recommended visits, emphasis on themes that relate to priority areas identified by this workgroup – E.g. Anticipatory guidance and parental education related to social emotional development and health; addressing parental health and social determinants of health – Barriers to existing metrics in counting the quantity and not quality of well‐visit experiences
– Make a recommendation to Health Evidence Review Committee to develop statement on the evidence for social‐emotional screening
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HAKR Final Report Conceptual Framework, Measure Criteria, Areas of Priority, Proposal to M&S, Areas for New Measure Development, Recommendations to HPQM, OHPB, Health Equity Measures Workgroup, HERC, etc.
Recommendations to Health Plan Quality Metrics Committee (HPQM)
Metrics and Scoring adoption (required)
by M&S and potentially other plans (PEBB, OEBB) Example: Consider inclusion of all metrics HAKR workgroup rated highly. If on HPQMC list, would add weight for use by others (e.g. for VBP, contracting, etc.) Current measure list N=51
Proposal to Metrics and Scoring (M&S)
strategy
that strategy
Current set N=19
Discussion in October
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