Metrics & Scoring Committee July 21, 2017 HEALTH POLICY & ANALYTICS Office of Health Analytics
Welcome new member! Dr. Helen Bellanca, Associate Medical Director at Health Share of Oregon. Helen is joining us as a CCO representative. Her term officially starts in August. Also in August, Will Brake will begin as Committee Chair, and the Committee will select a new Vice-Chair. Ken, Eli, Will, Daniel, and Thomas have all been reappointed to continue on the Committee. 2
Consent agenda Review today’s agenda Approve June minutes Written updates (HPQCM next slide) 3
Health Plan Quality Metrics Committee Met July 13 th and heard a proposal from Ken House and Will Brake • to establish a workgroup, supported by the Children’s Institute, to create an overarching measure of kindergarten readiness. The Committee supported the proposal and asked for an update with vision and deliverables within the next 3-6 months. • The Committee then began to review candidate measures for two domains and conducted a “first pass” vote on whether individual measures should remain in candidate pool moving forward. This work will continue at the August 10 th meeting. • Metrics & Scoring will present its formal proposal in October. • Meeting information and materials are available online at: http://www.oregon.gov/oha/hpa/analytics/Pages/Quality-Metrics- Committee.aspx 4
Public testimony HEALTH POLICY & ANALYTICS Office of Health Analytics 5
Finalize 2018 Measure Set HEALTH POLICY & ANALYTICS Office of Health Analytics 6
Effective Contraceptive Use • TAG recommendation was to modify the specifications to include permanent numerator credit for tubal ligation • The Committee supported changing the specifications to account for tubal ligations, but wanted to see additional data before deciding on whether to: (a) modify the lookback period to give permanent numerator credit for tubal ligations ever previously received or (b) exclude woman who previously had tubal ligation from the denominator (credit would be given in year tubal conducted; member would be excluded in subsequent measurement periods) • Committee asked OHA to test both approaches 7
Effective Contraceptive Use • OHA tested the two options (see ‘ECU tubal ligation options’ in meeting materials and found): – When looking within the same year , Method 1 (permanent numerator credits for tubals) increased the overall rate from the current specs by 7 points in 2015, and 6 in 2016; significantly larger increases than Method 2 (tubal as numerator credit in first year, then permanent exclusion), less than 1 point higher for both years. – With method 1, all CCOs see rates elevated, up to 9 points higher, or a 24% increase in numerator hits. – Some CCOs might see rates lowered under method 2, in particular, the higher performing CCOs such as PrimaryHealth and Umpqua which had around 4 points lower rates in 2016, compared to the current specs (“good denominator” being excluded phenomenon ). – When comparing rate changes from 2015 to 2016, under the current specs the statewide CCO rate had increased by 3.4%, but both method 1 and 2 resulted in smaller improvements, at 3.2% and 2.8%, respectively. 8
Effective Contraceptive Use • Additional considerations – How would these changes impact benchmarking? – The nationally endorsed measure is in line with the current Oregon ECU specifications and only grants numerator credit for tubals associated with a surveillance code within the measurement year. • After looking at these data, and reviewing the specifications for the national measure, OHA does not recommend making this change to the specifications. • Committee decision? 9
Clarifications – 1 • OHA recommended CAHPS measure (new): – See CAHPS recommendations handout in packet – Add prevention or coordination questions (with preference for coordination questions, which are): • Q22 Personal doctor seemed informed and up-to-date about care received from other doctors/providers • Q40 Child's personal doctor seemed informed and up-to-date about care from other doctors or providers 10
Clarifications - 2 • Adult metric (NQF 0421) – BMI screening and follow-up plan (adult) • Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter • Child metric (NQF 0024) – Weight assessment & counseling for nutrition and physical activity (children and adolescents) – Percentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported. • Percentage of patients with height, weight, and body mass index (BMI) percentile documentation • Percentage of patients with counseling for nutrition • Percentage of patients with counseling for physical activity 11
Clarifications - 3 • Additional information on evidence-based obesity efforts provided by the HERC (see materials) show greater alignment with the adult than the child measure. • In addition, beginning January 2018 the Prioritized List guideline note on behavioral counseling (line 325) intentionally only calls out “intensive counseling” (> mthly face -to-face) • OHA therefore recommends that the Committee include the adult, rather than the child measure, in the 2018 measure set as it is more in line with the evidence-based practices outlined by the HERC . • Ideally there could be a glide path in future years towards prevalence and/or intensive counseling. 12
No Measure 1 Child obesity - BMI, nutrition and activity counseling* 2 Diabetes HbA1c control* 3 ED utilization - general pop* 4 Smoking prevalence* 5 Childhood immunizations* 6 Colorectal cancer screening* 7 Dental sealants for children* 8 Developmental screening* 9 Disparity Measure – ED utilization of members with mental illness 10 Assessments for children in foster care (physical, mental, dental)* 11 CAHPS - access to care (bundled)* 12 Controlling high blood pressure* 13 Depression screening* 14 Effective contraceptive use* 15 PCPCH* 16 Timely prenatal care* 17 Adolescent well-care visits* 18 Follow-up after hospitalization for mental illness 19 Preventive dental utilization for adults 20 CAHPS – satisfaction 21 CAHPS - shared decision-making ( should be characterized as coordination) 13
Select 2018 Challenge Pool 14
OHA Recommendations – Health Aspects of Kindergarten Readiness OHA staff recommendation 1. Frame the 2018 challenge pool as focusing on measures that may have an impact on the health aspects of kindergarten readiness (Committee would need to select measures from final 2018 list). 2. Challenge pool payment would be contingent upon meeting all measures in the challenge pool. 3. If no CCO meets all challenge pool measures, revert to current methodology (payment per measure in challenge pool) or award CCOs achieving x-1 (e.g. 3 of 4) total measures. Rationale: • In the absence of a comprehensive measure of kindergarten readiness, this approach clearly indicates the Committee’s commitment to cross - sector coordination for this often neglected population. • CCOs could still achieve payment on the individual measures outside 15 the challenge pool.
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Percent of quality pool earned in phase 1, and total percent earned with challenge pool. (Dollar values shown in parentheses) 18
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