Metrics & Scoring Committee May 18, 2018 HEALTH POLICY & ANALYTICS Office of Health Analytics
Today’s Agenda Welcome – Welcome Dr. Amit Shah! – Review and approve April minutes – HPQMC debrief – Updates (written and measure development) – CCO 2.0 standing update 2019 measure set – prenatal care staff recommendation Presentation on PCORI BHI study Presentation on first Public Health Accountability Report Discussion – 2019 measure set implications Please note this meeting is being recorded. The recording will be made available on the Committee’s webpage: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics- Scoring-Committee.aspx 2
Review April Minutes 3
Committee Appointments - Reminder • In July 2018, two Committee members will ‘term out’, and five additional members will need to reapply if they wish to continue from August 2018 on. • All applications (including from current members who would need to reapply) are due to metrics.questions@state.or.us by May 23 rd . • OHA is specifically looking for one member with oral health expertise, and has an interest in members who can support the Committee in promoting health equity. 4
Health Plan Quality Metrics Committee (1/2) • Met May 10th – Final review and approval of 2019 measure set, including identification of the following three ‘on deck’ measures (to be added to HPQMC list in 2021) • Current non- incentivized postpartum care measure will be replaced with ‘post - partum follow- up and care coordination’ • Depression screening and follow-up for adolescents and adults will replace current depression screening measure • Optimal asthma control will replace asthma controller therapy on menu – Discussed aligned measure set gaps to aid in prioritizing initial list of 20 developmental measures 5
Health Plan Quality Metrics Committee (2/2) • The following ‘developmental’ measures were prioritized: – Developmental screening follow-up – Evidence obesity measure – Identification of suicide prevention measure – Kindergarten readiness – Children and youth with special health care needs survey (based on questions from FECC, PICS, and CAHPS) – Unexpected complications in term newborns – Food insecurity screening – Screening measure for Hep C and HIV (two measures, but potentially similar or parallel development process) • Will meet again June 14 th 6
Measure Development Work • Health aspects of kindergarten readiness measure development – Measure selection framework shared with ELC’s Measuring Success Committee, and aligns with framework being utilized for early learning system dashboard – Third meeting is May 25th. Discussion will include: adoption of measure selection criteria; application of conceptual framework; and review of potential measures for Phase 1 recommendations. – More substantive update (including framework) will be included in June M&S materials • Evidence-based obesity measure – Kick-off meeting scheduled for May 31 st . – June M&S meeting will include check-in on scope, etc. 7
Standing CCO 2.0 Update Stephanie Jarem, OHA 8
Public testimony HEALTH POLICY & ANALYTICS Office of Health Analytics 9
2019 Prenatal / Postpartum Care Measure – OHA Staff Recommendation Anna Stiefvater, RN, MPH - OHA Maternal and Child Health Sara Kleinschmit, MSc – OHA Office of Health Analytics 10
Importance of Postpartum Care 11
Fourth Trimester (3 months postpartum) • Challenges – Recovery from pregnancy, labor & delivery and newborn care – Return to tobacco use (and other substance use) – Fragmented care – Little formal or informal support • Opportunities – Reproductive life planning and contraception – Management of chronic health conditions – Linkages to ongoing care & services – Sensitive period of time with links to life course outcomes (maternal depression, breastfeeding)
State of Health Care Quality Report: HEDIS Measures of Care (United States) POSTPARTUM VISIT BETWEEN 21 AND 56 DAYS AFTER DELIVERY Commercial Medicaid Medicare Year HMO PPO HMO HMO PPO 2016 74.1 65.9 63.7 -- -- – – 2015 73.2 63.1 60.9 – – 2014 76.9 68.4 61.8 – – 2013 80.7 70.9 61.3 – – 2012 80.1 70.0 63.0 – – 2011 80.6 71.3 64.1 – – 2010 80.7 65.9 64.4 National Committee for Quality Assurance (NCQA) http://www.ncqa.org/report-cards/health-plans/state-of-health-care- quality/2017-table-of-contents/perinatal-care 13
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AMCHP Postpartum Think-Tank meeting, December 2014 15
AMCHP Postpartum Think-Tank meeting, December 2014 16
Key References ACOG Optimizing Postpartum Care https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on- Obstetric-Practice/Optimizing-Postpartum-Care Cornell, A., McCoy, C., Stampfel, C., Bonzon, E., & Verbiest, S. (2016). Creating New Strategies to Enhance Postpartum Health and Wellness. Maternal and Child Health Journal, 20(Suppl 1), 39 – 42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290048/pdf/10995_2016_Article_2182.pdf Resources on Strategies to Improve Postpartum Care Among Medicaid and CHIP Populations, Centers for Medicare & Medicaid Services (CMS) https://www.medicaid.gov/medicaid/quality-of-care/downloads/strategies-to-improve-postpartum- care.pdf 17
CCO Performance, and Opportunity 18
Statewide Performance – Preliminary 2017 Timeliness of prenatal care NOTE: 2011 and 2013 are not directly comparable to later years due to a change in methodology beginning in 2014 (inclusion of medical record data). 19
Statewide Performance – Preliminary 2017 Postpartum care rate NOTE: 2011 and 2013 are not directly comparable to later years due to a change in methodology beginning in 2014 (inclusion of medical record data). 20
OHA staff recommendation Bundle prenatal + postpartum care measure. To achieve measure, CCOs must meet benchmarks for both. Rationale: • Measures are part of a continuum of care , lending to joint accountability • In 2021 HPQMC changing postpartum care measure to only include women who make their appointment . Focus on supporting women in attending their visits now sets system up for success on this new measure. • Aligns with efforts to reduce maternal mortality and morbidity and helps address racial and ethnic disparities in this area (e.g., new Maternal Mortality and Morbidity Review Commission; inequities in postpartum outcomes for women of color). • Work in postpartum arena supports CCOs in other areas , including effective contraceptive use measure. • Postpartum care essential to interconception health , setting state for healthy subsequent pregnancy and birth. • Should this be incentivized, OHA’s Transformation Center and Public Health Division are poised to provide supports to CCOs to achieve the measure. 21
Discussion of OHA Proposal 22
Caring aring for or th the Wh Whole P ole Person: son: A Patient-Centered Assessment of Integrated Care Oregon CCO Metrics & Scoring Committee May 18, 2018 Bill J Wright, PhD Natalie Kenton, MS, MPH Acknowledgements This study was a partnership between CORE (The Center for Outcomes Research & Education at Providence St Joseph Health) and CHSE (The Center for Health Systems Effectiveness at OHSU). Support for the research was provided by PCORI (The Patient-Centered Outcomes Research Institute).
St Study udy Ob Object jectiv ives es Measure the impact of integration, and the distinct 1 elements of integration, on patient – centered outcomes . Measure the impact of integration, and the distinct 2 elements of integration, on claims-based quality outcomes. 3 Measure the impact of stigma on the integrated care outcomes that matter most to patients.
Rethinking thinking In Integrat egration ion How A Patient-Centered Lens Transformed Our Approach OUR ORIGINAL RESEARCH PLAN FOCUSED ON STRUCTURAL INTEGRATION. 1 We designed the study to look at structural and organizational changes of “integration.” 2 OUR PATIENT ADVISORY TEAM ENCOURAGED US TO EXPAND OUR THINKING. The PAT told us that integration isn’t just a structural phenomenon to patients, it’s an experiential one. They were worried that stigma was a “first order” challenge for behavioral health integration, and that health systems weren't thinking much about this in their work. SO WE ADAPTED THE DESIGN: 3 We changed our survey and interviews to include a third aim designed to explore the role of stigma in integration.
Stu tudy dy Design esign WE FOLLOWED A RANDOM SAMPLE OF ABOUT 11,000 PATIENTS WHO WENT TO ONE OF OUR 12 PARTICIPATING CLINICS IN THE PORTLAND & BEND AREAS. 2 years of in-depth interviews with 2 years of data from the clinics on patients & providers. their integration models. 2 years of claims data from 2 years of survey responses from patients at study clinics. the patient panel. WE ASSESSED OUTCOMES FOR PATIENTS AT EACH CLINIC; THEN TESTED WHETHER THE INTEGRATION ELEMENTS PRESENT IN THOSE CLINICS WERE ASSOCIATED WITH BETTER IMPROVEMENT IN OUTCOMES OVER TIME.
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