Metrics & Scoring Committee February 26, 2016
*Approve January minutes Consent agenda
Agenda Overview • Updates • Public testimony • Continue discussion on framework and mechanics for CCO incentive program under new waiver • Presentation on Public Health Modernization / State Health Improvement Plan priority areas
• Year Three Clinical Quality Metrics • Hospital Transformation Performance Program • Medicaid waiver renewal
Public Testimony
CONTINUED DISCUSSION ON FRAMEWORK AND MECHANICS FOR CCO INCENTIVE PROGRAM UNDER NEW WAIVER
January Recap The Committee began thinking about the structure of the incentive measure program under the new waiver, specifically establishing a core and menu set approach to the incentive measures. Extensive discussion on measurement fatigue, measure alignment, measuring transformation and integration, supporting local priorities, and more. Committee members were given homework to ponder in advance of discussion today.
What does a transformed system look like to you? What will tell you that health system transformation in Oregon has been successful?
Which few (2-3) measures would you incentivize to get there?
What are the outcome and process measures for these incentive measures?
Incentive Measure Program Structure As requested by Committee, staff consulted with Michael Bailit to identify potential variations for quality pool distribution if the CCO incentive measure program moves to a core / menu set approach for the new Medicaid demonstration waiver (2018 – 2022). See handout for full description of these options. Note all options assume that the Committee will select a fixed number of measures in the core and menu sets, and that there will be a total number of measures that all CCOs are held accountable for (even if which measures vary by CCO due to menu selection).
Current Quality Pool Structure (2015) Number of Measures Met % of quality pool payment for which CCO is eligible At least 12 (inc. EHR adoption, PCPCH enrollment) 100% At least 12 (not inc. EHR or PCPCH) 90% At least 11.6 80% At least 10.6 70% At least 8.6 60% At least 6.6 50% At least 4.6 40% At least 3.6 30% At least 2.6 30% At least 1.6 10% At least 0.6 5% Fewer than 0.6 No quality pool payment
Levers for Quality Pool Distribution Variations for the quality pool distribution can be summarized as three levers that can be used independently, or in combination. 1) Raise or lower the “gate” (the minimum score needed for any payment) 2) Raise or lower the rungs of the “ladder” (levels of performance needed to earn payment, how high is the top of the ladder) 3) Allow for variable point allocation for all measures, or just menu measures.
Variations: Tiered Approaches • Continue to utilize a tiered approach + challenge pool. • Option 1a: recommend total number of measures required to earn 100% of the quality pool. • Option 1b: raise or lower the bar, require higher (or lower) level of performance to earn 100% of the quality pool. % of quality pool payment Number of Number of Number of for which CCO is eligible measures met measures met measures met (easy) (medium) (hard) 9 11 12 100% 8 10 11 90% 7 8 10 80% 6 6 8 60%
Variations: Tiered Approaches (1b) 12 measures at $10 each = $120 quality pool available per CCO CCO A meets 11 measures, earns $110 of $120 available; $10 remaining goes toward challenge pool. CCO B meets 9 measures, earns $90 of $120 available; $30 remaining goes toward challenge pool.
Variations: Variable Weights • Each measure (core and menu) is assigned a point value. Committee recommends total point value that must be met to earn quality pool (can still have tiered distribution). • Option 2a: all measures are worth the same point value. • Option 2b: core measures are worth 1 point; menu measures lower point value.
Variations: Variable Weights (cont.) • Option 2c: Recommend higher or lower weights to certain measures to provide emphasis in certain areas (e.g., more transformational measures are worth more points). • Option 2d: Assign full point value for meeting the benchmark (1 pt) and fewer points for meeting improvement targets (½ pt). Likely demotivating to CCOs – not recommended at this time.
Next Steps?
Public Health Modernization and the State Health Improvement Plan Lillian Shirley, BSN, MPH, MPA Public Health Director Oregon Health Authority Metrics and Scoring Committee February 26, 2016 PUBLIC HEALTH DIVISION Office of the State Public Health Director
Modernization of Oregon’s Public Health System 21
What does governmental public health do?
Task Force on the Future of Public Health Services • Met in 2014 to develop recommendations for a public health system for the future. • The Modernizing Oregon’s Public Health System report was submitted to the legislature in Sept 2014. 23
House Bill 3100 (2015) Put into place the recommendations from the Modernizing Oregon’s Public Health System report: • Adopts the foundational capabilities and programs for governmental public health. • Changes the composition and role of the Public Health Advisory Board beginning on January 1, 2016. • Requires the Oregon Health Authority’s Public Health Division and local public health authorities to assess their current ability to implement the foundational capabilities and programs; and requires the Public Health Division to submit a report on these findings to the legislature by June 2016. • Requires local public health authorities to submit plans for implementing the foundational capabilities and programs by December 2023. 24
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Why modernize Oregon’s public health system? • Public health has traditionally provided a safety net for individuals without health insurance, and due to the Affordable Care Act, Oregon’s uninsured rate has plummeted. • Without needing to provide health care for a substantial number of uninsured individuals, public health can focus on developing policies and programs that can sustain lifelong health for everyone. • A focus on policies and programs that can help everyone be healthy will yield cost and time savings for the health care delivery system. • Investments in public health vary from county to county, leading to disparities in services. • Oregon’s public health system relies heavily on federal categorical grants, which do not always meet the unique needs of our state. 26
What does public health modernization mean for my community? • Modernization of public health means that everyone in Oregon will be served by a health department that provides for: – Timely and comprehensive data on the health of their population in order to inform community health assessments and community health improvement plans; – Response to emerging health threats like natural disasters and communicable diseases; – Clear and comprehensive communications about important health issues; – Assurance that community members have access to healthy foods and safe places to play and be active. 27
Progress to date • Developed a Public Health Modernization Manual, with detailed definitions for each foundational capability and program. • New Public Health Advisory Board members have been appointed by the Governor’s office. • Each state and local public health authority is currently assessing its ability to meet the foundational capabilities and programs. 28
Next steps Activity Timeline Public Health Advisory Board will meet monthly Throughout 2016 Public Health Division and local public health Jan-March 2016 authorities will assess ability to implement foundational capabilities and programs Submit report with assessment findings to the Oregon June 2016 legislature Identify health outcomes and cost savings attributable September 2016 to public health interventions With communities and partners, state and local health Beginning July 2016 departments will develop plans to implement the foundational capabilities and programs. 29
Performance measures • Per HB 3100, the Public Health Advisory Board will develop a plan for the use of incentives to encourage the effective and equitable provision of public health services. • This work is anticipated to begin in Spring 2016. 30
State Health Improvement Plan 31
Oregon’s State Health Improvement Plan will improve the health of all people in Oregon by 2020 by: Setting common goals Reducing Addressing the avoidable leading causes differences in of death, health outcomes disease, and among diverse injury communities
The Public Health Division has oversight of the SHIP. However, strategies won’t be met without broad engagement of health systems, community organizations, local public health, state agencies and others. 33
State Health Improvement Plan priorities • Prevent and Reduce Tobacco Use • Slow the Increase of Obesity • Improve Oral Health • Reduce Harms Associated with Substance Use • Prevent Deaths from Suicide • Improve Immunization Rates • Protect the Population from Communicable Diseases
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