Metrics & Scoring Committee
Consent Agenda Review today’s agenda Approve February minutes 2
Additional updates Metrics Coordinator ED utilization among members with SPMI – Reducing emergency department use with a focus on behavioral health (in preparation for the 2018 equity measure) will be a topic at next the Innovation Café hosted by the OHA Transformation Center (May 9) – More information: http://www.oregon.gov/oha/Transformation- Center/Pages/Innovation-Cafe.aspx – Registration: https://www.eventbrite.com/e/2017-innovation-cafe- improving-key-health-metrics-registration-32133641587 3
Additional Discussion on Patient Experience Measures Charles Gallia, OHA 4
The Triple Aims Each survey represents the voice of one important person with a valid perspective.
CAHPS Health Plan Survey Incentive Measure • Getting Needed care Access to Care • Getting Care Quickly • How Well Doctors Communicate • Customer Service Incentive Measure • Rating Questions Called Satisfaction with Care • Shared Decision Making • Access to Specialized Services • Access to Prescription Medicine • Experience with Personal Doctor • Coordination of Care (Child Only) • Family Centered Care: Personal Doctor who Knows Child • Children with Chronic Conditions’ experience • Cultural Competency • Health Literacy • Flu shot, Assistance with Smoking Cessation (Adults Only) 6
7 (Enter) Division or Office (Mixed Case) Satatewide (Enter) DEPARTMENT (ALL CAPS) Average 65 70 75 80 85 90 Child: Getting Emergency Care 88.6 Adult: Getting Example of Important Finding: Access to Care Emergency Care 81.5 Child: Getting Routine Care 85.6 Adult: Getting Routine Care 78.6 Adult: Getting Care 80.1 Quickly Composite Child: Getting Care Quickly Composite 87.1 Adult Getting Specialist Care 77.6 Child Getting Specialist Care 75.5 Child:Customer Service 84 Adult: Customer Service 82
Subgroup Analysis Access to Access to Access to Getting care Rating of needed needed special needed quickly health plan treatment or equipment therapy counseling Children with 68% 73% 62% 85% 50% Chronic Conditions Children Without 68% 80% 80% 86% 63% Chronic Conditions 8
CAHPS Child's HP or doctor's office helped parent/guardian get needed treatment/counseling A CCO level cross-tabulation of CCC (developmental or emotional or behavioral problem for which a subset of children with treatment or counseling is chronic conditions, those who needed) Yes No Total 48.0% 52.0% 25 AHP have a persistent Cascade 60.0% 40.0% 35 social/emotional concern, by CPCCO 65.2% 34.0% 23 whether assistance in getting EOCCO 38.0% 63.0% 24 FAMILYCARE 50.0% 50.0% 20 treatment/counceling was IHN 46.0% 54.0% 26 provided by health plan or JCC 47.1% 52.9% 17 provider’s office PSCS 68.0% 32.0% 25 PSG 86.4% 13.6% 22 PHJC 38.0% 63.0% 24 TRILLIUM 48.7% 51.3% 39 UMQUA 32.0% 68.0% 19 WOAH 50.0% 50.0% 22 WVCH 65.0% 35.0% 20 YCCO 51.6% 48.4% 31 HEALTHSHARE 64.0% 36.0% 25 OHP 53.3% 46.7% 435 9
Plan level interventions • • Open Access Scheduling for Shared Decision-making Routine and Urgent Appointments • Support Groups and Self-Care • Streamlined Patient Flow • Delivery of Evidence-Based • Email for Administrative Help and Information Clinical Advice • Planned Visits • Internet for Health Information and • Group Visits Advice • Listening Posts • Rapid Referral Programs • Patient and Family Advisory • Policies and Processes and Councils Applications of Information • Service Recovery Programs Technology • Standards for Customer Service • Training to Advance Physicians’ • Reminder Systems for Preventive Communication Skills Services and Immunizations • Tools to Help Patients • Developing Shared Care Plans Communicate Their Needs 10
State-level interventions • • Encourage Trauma-Focused Best, and just good- Cognitive Behavioral Therapy practices highlights (TF-CBT), through CME and • Make it easy to select as a MOC performance improvement • Disseminating Evidence-Based area for CCOs Practice For Children & • Healthy Communities Adolescents challenge, foundation • Community Preparation supported • OHA generated Community • Contract specs Profiles, estimates, need and gap analyses • Policy and procedures • Incredible years reviews • EQRO Clinical Focus Study • Your thoughts? • CAHPS CCO – Sub analysis 11
Considerations/ suggestions • Align with PRQRS • Focus on low performing areas or ones with variation between Plans • Is there an action pathway? • Align with other metrics, complementary • Drivers of ratings – Emphasis on prevention – Shared decision-making – Being ‘up to date’ about care from other providers – Developing trust • Separate Child and Adult Access 12
Oral Health in Oregon CCOs: A Metrics Report March 17, 2017 Metrics & Scoring Committee Meeting
Presentation overview • Background and context for oral health metrics reporting on CCOs • Measures of oral health in Oregon CCOs – preliminary data • Q&A and discussion 14
Background and context: Oral health in Oregon CCOs
Oral health is fundamental to coordinated care model • A growing body of evidence shows oral health is linked to overall health: Heart disease Diabetes Low birth weight Certain cancers Well-being Missed school/work days • Integration of physical, oral and behavioral health care is a key goal of health system transformation and Oregon CCOs – Oral health in CCO global budget: Jul 2014 – ½ of CCOs included oral health in Transformation Plans – CCO incentive metrics: dental sealants, foster care 16
Oral health in Oregon CCOs…where are we now? 17
Stakeholders identified key oral health metrics Dental Quality Metrics CCO Oregon Dental MAC Oral Health WG WG WG Purpose Dental quality metrics for Quality metrics core Oral health CCO incentives to Metrics and a la carte set for monitoring & Scoring Committee use in CCO contracts measures for understanding access in OHP • Key Current measures CCO-DCO Quality 15 total measures measures selected by Metrics & Measure Sets under 6 priorities of Scoring Committee: access: provider dental sealants and Utilization, patient distribution, foster care experience, care utilization (quality of • Addtl measures for coordination (ED use), services), patient monitoring/incentives measures focused on experience, care recommended specific populations coordination, (e.g. pregnant women, integration, patient- people with diabetes) centered care 18
Measures overview Measure Endorsed by Utilization (Quality of Services) Any preventive service (adults & children) MAC, CCO OR Any dental services – adults & children MAC, Dental Quality Topical fluoride varnish Dental Quality Patient Experience Regular dentist Dental Quality Access to emergency care MAC, Dental Quality Care Coordination Follow-up after ED visit for dental reasons MAC, CCO OR Oral health evaluation for patients with periodontitis MAC, CCO OR Integration Dental care for adults with diabetes MAC, CCO OR 19
Some caveats • Much of the data in this report are being produced for the first time • Some data used preliminary specifications, courtesy of the national Dental Quality Alliance (DQA) • Some measures recommended by the Medicaid Advisory Committee’s Oral Health Workgroup not yet available: – New CAHPS questions: dental provider explanations to patient; customer service experience 20
Utilization (quality of services) 21
Statewide: 2015 — 33.0% Mid-2016 — 33.7% 22
Statewide: 2015 — 53.1% Mid-2016 — 54.8% 23
Statewide: 2015--18.1% Mid-2016--19.4% 24
Statewide: 2015 — 48.3% Mid-2016 — 50.1% 25
Statewide: 2015 — 14.5% Mid-2016 — 16.3% 26
Patient Experience 27
Statewide: child — 79% adult — 57% 28
Statewide: child — 52% adult — 44% 29
Care Coordination 30
Statewide: 2015 — 36.6% Mid-2016 — 37.1% 31
Statewide: 2015 — 13.7% Mid-2016 — 14.7% 32
Integration 33
Statewide: 2015 — 24.2% Mid-2016 — 24.1% 34
Questions? Amanda Peden, Policy Analyst, Office of Health Policy Health Policy & Analytics Division amanda.m.peden@state.or.us 35
Discussion 37
• Each Committee member to create their own “short list” of measures for 2018. • This includes any of the current measures that should be included / dropped moving forward, plus any new measures from the topics that have been explored to date. • Please email your shortlist to milena.malone@state.or.us by Friday, April 7 th • Staff will compile and bring back for discussion at our April meeting. 38
Next Meeting: April 21, 2017
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