HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP July 27 th , 2019 1
Agenda • Meeting goals and agenda overview o Equity and the social determinants of health o Refresher: Where we are headed • Public comment (10:20 AM) • HAKR workgroup priority areas o “Near ready” metrics we will not be examining further o “Near ready” metrics with minimal interest: staff team proposals o “Near ready” metrics with significant interest in exploring further Review of each metric HAKR Workgroup assessment • Summary and next steps 2
Equity and the Social Determinants of Health Health Equity Means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing economic and social obstacles to health such as poverty and discrimination. (Robert Wood Johnson Foundation) (Adapted from McGinnis et al., 2002) 3
Refr efreshe esher: Wher here W e We e Ar Are Head e Headed ed 4 4
Options for Proposals to Metrics and Scoring Committee in Fall 2018 Proposal Options: 1) A Only 2) A + B, Proposal for C 3) A, Proposal for C 4) B + C 5)A, Proposal C * HAKR staff team is leaning towards this option 5
Timeline and Work Plan June July August October September • Clarify options for • Review “near • Conclude review • Prioritize options • Review ready” metrics for of “near ready” moving forward for measure workgroup report Phase 2 (2019+) metrics recommendations with final • Conclude review recommendations of “ready” metrics • Assess “near • Review glide path • Build consensus ready” metrics • Prepare for for Phase 1 metrics for Phase on final (2018) using workgroup 1 (2018) workgroup November measure criteria recommendations presentation to • Review and • Summarize all Metrics and gather input on measure Scoring potential “near recommendation Committee ready” metrics for options (“ready”, “near ready”, Phase 2 (2019+) glide path) • Document interest in “new” metrics 6
Public Comment 7
“Near Ready” Metr Metrics ics tha that t Ad Addr dress HAKR ess HAKR Wor orkg kgroup oup Priority Priority Ar Areas eas 8
HAKR Priority Areas – “Near Ready” Metrics Identified Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection (5 CCO metrics, 4 Available Phase 1 Metric) 1. Vision Screening 2. Psychosocial Screening Using the Pediatric Symptom Checklist-Tool 3. Maternal depression screening in child’s visits HAKR Conceptual Domain: Follow-Up to Address Risks Identified (No current CCO metrics or available Phase 1 Metric) 4. Mental health utilization 5. Use of first line psychosocial care for children and adolescents on antipsychotics. 6. Follow-up to Developmental Screening* + HAKR Conceptual Domain: Care for CYSHCN + (No current CCO metrics or available Phase 1 Metric) 7. Family Experience of Care Coordination + 8. Pediatric Integrated Care Survey + Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection (2 CCO Metrics) 9. Unexpected newborn complications 10. Low-birth weight 11. Behavioral health risk assessment for pregnant women * Metric identified by Metrics & Scoring 12. Prenatal and Postpartum Depression Screening + Metric identified by Health Plan Quality Metrics 9
Three “Near Ready” Metrics We Will Not Be Examining Further Population: Children HAKR Conceptual Domain: Follow-Up to Address Risks Identified • Use of first line psychosocial care for children and adolescents on antipsychotics Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Unexpected newborn complications • Prenatal and postpartum depression screening 10
Four “Near Ready” Metrics With Minimal Interest (HAKR Staff Team Has Developed Proposals) Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Vision Screening HAKR Conceptual Domain: Follow-Up to Address Risks Identified • Family Experience of Care Coordination + • Pediatric Integrated Care Survey + Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Low-birth weight * Metric identified by Metrics & Scoring + Metric identified by Health Plan Quality Metrics 11
Vision Screening • Vision is a component of the 3 to 6 year-old well-child visits. – One “ready” metric the workgroup has assessed is Well -Child Visits for Children 3-6. • Requires medical chart review for what was documented in the medical chart regarding what happened during the visit. – If a metric based on medical chart review of well-child visits was considered, may be valuable to consider multi-part metric that would include various components of the well-child visit and include vision screening. HAKR Staff Team Proposal : • Include vision screening as a component of a new metric proposed by various HAKR workgroup members focused on quality of well-child visits that we will be assessing later in the summer. • When we re-evaluate the Well-Child Visit for Children 3-6 metric, remind HAKR workgroup that vision screening is meant to be a component of those visits. 12
Surveys of CYSHN - Family Experience of Care Coordination (FECC) & Pediatric Integrated Care Survey (PICS ) • Children and Youth with Special Health Care Needs are an important population (1 in 5 children) that have unique needs and require specific supports to be ready for kindergarten. • FECC and PICS require new data collection with a new survey completed by parents. – This requires new resources that pose a significant barrier to adoption of the metric. • CCOs have found challenges in using data based on the CAHPS (a survey currently in the incentive program) due to the survey administration process, sample of respondents, and other factors. – Innovative sampling and administration methods may enhance usability, but require new work. • Health Plan Quality Metrics (HPQM) has identified metrics for CYSHN at-large (0-21) and these specific metrics as a priority for development. HAKR Staff Team Proposal : • Make a recommendation to HPQM that: – Supports their focus on developing valid, meaningful and feasible metrics focused on CYSHN. – Supports a feasible and meaningful patient experience survey specific to CYSHCN. • Examine options for stratifying the metrics identified by CYSHN. 13
Low Birthweight • Addressing low birthweight and the various and complex factors that contribute to low birthweight would require transformative action within the health system and addressing developmental origins of health. (Aligned with HAKR criteria.) • There are significant disparities in birthweight and birth outcomes by race/ethnicity. • Methodologic issues with the current metric and data source: – Claims data underreports the level of low birthweight. – Metric has reliability and validity issues. – Given those issues and Oregon demographics, current rates at a CCO population level are low which can be barrier to adoption within Metrics and Scoring. HAKR Staff Team Proposal : • Make a recommendation to the Oregon Health Policy Board and the Health Equity Measures Workgroup about the importance of addressing disparities in birth outcomes and developmental origins of health and disease. 14
Five “Near Ready” Metrics With Significant Interest Population: Births/Mothers HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Behavioral health risk assessment for pregnant women Population: Children HAKR Conceptual Domain: Prevention, Promotion, Early Detection • Psychosocial Screening Using the Pediatric Symptom Checklist Tool • Maternal depression screening in child’s visits HAKR Conceptual Domain: Follow-Up to Address Risks Identified • Follow-up to developmental screening* + • Mental health utilization * Metric identified by Metrics & Scoring + Metric identified by Health Plan Quality Metrics 15
Behavioral Health Risk Assessment for Pregnant Women • OHA reviewed and had discussions with subject matter experts, including the Centers for Medicare and Medicaid Services (CMS). • Metric was formerly on CMS Child Core Set. - Core Set was a group of metrics identified for Medicaid/CHIP agencies to report on. - CHIPRA Demonstration Grants supported state to pilot implementation of the metrics. • Reported by six states, but those states reported significant implementation issues. • There is no “measure steward” for the project who can update specifications and address implementation identified by states (which is needed). • CMS dropped the metric from the Child Core Set. HAKR Staff Team Decision : • Determined this measure is NOT “near ready,” but rather needs significant revisions and development that make it a “new” measure. It will not be assessed today given is it not a “near ready” metric. 16
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