HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP June 29th, 2018 1
Agenda • Meeting goals and agenda overview • Public comment (1:15 PM) • Refresher on Phases 1-3 and measures • Where we’ve been and where are we going • Workgroup areas of interest - Areas prioritized by workgroup - Conclude review of “ready” metrics for Phase 1 (2018) • “Near ready” metrics for Phase 2 (2019+) - Metrics with potential that have been identified - Temperature check - Process for exploring these metrics • Summary and Next Steps 2
Public Comment 3
“Ready” measure = Validated measure with specifications, applied use, and Shared benchmarks; meets four core requirements for CCO Incentive Metric Program; accountability measure ready for Phase 1 (2018) and cross- “Near ready” measure = Specifications developed, has been applied in some sector action setting, but not at a CCO/MCO/health system level; data connections need work; to achieve measure ready for Phase 2 (2019+) kindergarten “New” measure = Measure concept, no specifications, no applied use readiness Phase 2 Phase 3 Phase1 (2019+) (2020+) (2018) • Recommend one or more measures • Pilot/test any recommended • Explore potential to apply “near ready” measures of HAKR to be applied as CCO measures to other health plans incentive measures. Could include: and payers • If testing/development is • “Ready” measures for 2018 • Explore opportunities for shared complete, formally • Glide path measures for 2018 recommend any now “ready” measurement (e.g. integrating • “Near ready” measures for 2019+ measures for adoption the health system quality • Document interest in “new” measures into the early learning • Explore development of “new” measures system data dashboard) measures (if applicable and • Consider other recs to achieve • Explore opportunities for joint resources available) desired goals accountability 4
Workgroup Role: 2018 Within Scope • Adopt a conceptual framework for the health sector’s role in kindergarten readiness • Identify metrics that can operationalize components of the health sector’s role in kindergarten readiness to recommend to M&SC and HPQMC in Fall 2018 • “Ready” and “near ready” person -level metrics • Possible glide path CCO-level metrics Outside of Scope • Joint accountability with the Early Learning System • Health sector developing a new definition of kindergarten readiness • Health sector developing a new kindergarten assessment that measures child outcomes and abilities to administer within health care settings 5
Measure Criteria for “Ready” Metrics to be Proposed for Phase 1 (2018) 6 Created for HAKR Technical Work Group
Where We’ve Bee Been an n and d Wher here e We e Ar Are e Going Going 7 7
1) HAKR Conceptual Framework 2) HAKR Measurement Criteria 8
Options for Proposals to Metrics & Scoring Committee in Fall 2018 Potential 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 9
Current CCO Metrics & “Ready” Metrics Assessed for Phase 1 (2018) (Mean Score on HAKR Criteria Across HAKR Workgroup Members) 10
Options for Proposals to Metrics & Scoring Committee in Fall 2018 Potential 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 11
Example of an A + B + Proposal for C Option ( this is just an example ) Phase 1 Phase 1 (2018) Phase 2 (2019+) (2018) Glide Path “Near Ready” “Ready” Metric Metric Tied to Metrics Tied to CCO-Level Child/Parent-Level 1)WCV 3-6 Activities 2)Dental Domain of Mental (e.g. Phase Sealants Health (e.g. child related to behavioral mental health (Option A) health utilization) services for young (Option C) children) (Option B) 12
Timeline and Work Plan June July August September October • Clarify options for • Review “near • Review glide path • Prioritize options • Review moving forward ready” metrics for metrics for Phase for measure workgroup report Phase 2 (2019+) 1 (2018) recommendations with final • Conclude review recommendations of “ready” metrics • Assess “near • Summarize all • Build consensus for Phase 1 (2018) ready” metrics options for on final using workgroup measure workgroup • Review and gather measure criteria recommendations recommendations input on potential (“ready”, “near “near ready” ready”, glide path) metrics for Phase 2 (2019+) • Document interest in “new” metrics 13
Review of view of Metrics Metrics tha that t Ad Addr dress ess Wor orkg kgroup oup Inter Interest est Ar Areas eas 14
Areas of HAKR Workgroup Interest & Parent Focus Group Priorities: Metrics at a Child-level 15
Areas of HAKR Workgroup Interest & Parent Focus Group Priorities: Metrics at a Mother or Parent/Caregiver Level 16
Reviewed Whether There are Available Metrics to Address HAKR Priority Areas • Literature and metric website search for applicable metrics – National Quality Forum – National Quality Metrics Clearing House – http://www.buyingvalue.org/resources/toolkit/ – Professional consultation • No additional “Ready” metrics for Phase 1 (2018) in your priority areas • Identified a set of “Near Ready” metrics that could be considered for Phase 2 (2019+) because they have established specifications and have been implemented • Examples of reasons they did not meet criteria for “Ready” metrics for Phase 1 (2018) – Not designed with a health system analysis – Data source = medical chart review – Denominator is all children or adults, hasn’t been applied for children 0 -6 – Requires new data connections across systems – Requires policies or policy clarifications, payments and capacity 17
HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified 18
HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified 19
HAKR Priority Areas for Which There Are “Near Ready” Metrics Identified 20
Experience of Care Metrics Based on CAHPS HP - 5 CAHPS HP 5 Items on Experience - Under the section on the child’s personal doctor or nurse, there are these items: • 12. In the last 6 months, how often did your child’s personal doctor explain things about your child’s health in a way that was easy to understand? • 13. In the last 6 months, how often did your child’s personal doctor listen carefully to you? • 14. In the last 6 months, how often did your child’s personal doctor show respect for what you had to say? • 15. Is your child able to talk with doctors about his or her health care? 1 Yes 2 No → If No, go to #17 – 16. In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy for your child to understand? – 17. In the last 6 months, how often did your child’s personal doctor spend enough time with your child? Limitation to Current Sampling, Timing of Data Collection, and Past CCO Experiences in “Attainability” of Improving on the CAHPS Metrics ❖ Sample is ONLY for parents of children 0-6 who indicated they had a personal doctor or nurse and could answer these questions and be included in the denominator for the metric, likely to not have enough sample for an incentive metric ❖ Data reported and available nearly a year after it is collected ❖ Data not actionable in targeting who or where there are needs for improvement as it is not collected at a clinic-level but is for a subset for population 21
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 and Scoring 12. Prenatal and Postpartum Depression Screening + Metric identified by HPQM 22
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