Metrics & Scoring Committee September 15, 2017 HEALTH POLICY - PowerPoint PPT Presentation

Metrics & Scoring Committee September 15, 2017 HEALTH POLICY & ANALYTICS Office of Health Analytics

Consent agenda  Review today’s agenda  Approve August minutes  Written updates (HPQMC next slide) 2

Health Plan Quality Metrics Committee • Met September 14 th and continued review of candidate measures • Next meeting: October 12, 2017, 1.30-4.00 • Meeting information and materials are available online at: http://www.oregon.gov/oha/hpa/analytics/Pages/Quality- Metrics-Committee.aspx 3

Vice-Chair elections 4

Public testimony HEALTH POLICY & ANALYTICS Office of Health Analytics 5

Finalize selection of 2018 benchmarks & improvement target floors 6

Recap: Benchmark decisions from last meeting (1/2) Measure Benchmark Improvement target TBD, 2017 national Medicaid 75 th percentile for (a) adults and (b) MN method with 2 Access to care (CAHPS) children; must achieve percentage point floor benchmark/improvement target on both for metric credit TBD, 2017 national Medicaid 75th MN method with 2 Adolescent well-care visits percentile (admin data) percentage point floor Ambulatory care: Emergency TBD/1,000 member months 2017 MN method with 2 department utilization National Medicaid 90th percentile percent floor Assessments for children in DHS MN method with 3 90%, Committee consensus custody percentage point floor TBD, 2017 National Medicaid 75th MN method with 2 Childhood immunization status percentile percentage point floor MN method with 1 Cigarette smoking prevalence 25%, Committee consensus percentage point floor 7

Recap: Benchmark decisions from last meeting (2/2) Measure Benchmark Improvement target MN method with 2 Colorectal cancer screening 54.0%, 2016 CCO 90th percentile percentage point floor TBD 2016 National Medicaid 90th MN method with 2 Controlling hypertension percentile percentage point floor Dental sealants on permanent MN method with 3 22.9%, 2016 CCO 75th percentile molars for children percentage point floor Depression screening and follow-up MN method with 3 63.0%, 2016 CCO 90th percentile plan percentage point floor Developmental screenings in the MN method with 3 74.0%, 2016 CCO 90th percentile first 36 months of life percentage point floor Patient-centered primary care home N/A – sliding scale with 60% threshold N/A enrollment 8

Remaining 2018 Benchmark Decisions • Diabetes HbA1c poor control • Effective contraceptive use – Note previous changes to 2018 specifications (1) permanent numerator credit for tubal ligations; (2) including adolescents in incentivized part of measure • Timeliness of prenatal care • Child obesity – BMI, nutrition and activity counseling • ED utilization among members experiencing mental illness 9

Who is in the denominator? Women who are abstinent Women who partner with women Women who are trying to 30% conceive Trouble spots (i.e. women who don’t need Women who had a hysterectomy or tubal contraception) more than 7 years ago Women with a Benchmark hysterectomy or tubal 50% not paid by Medicaid Excluded Women with a partner who has a Women with a 70% Women who are physiologically vasectomy hyst/ooph in past 7 capable of getting pregnant, are years paid by currently sexually active with men Medicaid and do not want to get pregnant Women who were (i.e. women who need pregnant in the contraception) measurement year who did not also receive contraception

2016 Statewide P Performance, b by R Report Type Reporting Mix Depression Hypertension Diabetes Statewide 48.0% 65.9% 25.4% Statewide – Medicaid 51.1% 66.4% 27.8% reporting Statewide – All payer 41.8% 65.4% 23.1% reporting

Time for a break. 12

Public health accountability metrics Opportunities for collaboration between CCOs and public health September 15, 2017 PUBLIC HEALTH DIVISION Office of the State Public Health Director

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2017-19 investment from the legislature • The Legislature included $5 million in the OHA budget for public health modernization. • The majority of this investment will be used to fund regional approaches for communicable disease control and reducing health disparities. • Funds remaining with OHA will be used to enhance population health surveillance and data system. PUBLIC HEALTH DIVISION Office of the State Public Health Director 17

PUBLIC HEALTH DIVISION Office of the State Public Health Director 18

Public health accountability metrics • In June, the Public Health Advisory Board adopted a set of eight accountability metrics for the public health system. These metrics will be used to: – Track progress toward the modernization of Oregon’s public health system; – Bring focus to Oregon’s population health priorities; – Highlight areas where public health and other sectors can work together to achieve shared goals. • These metrics are not tied to local public health funding at this time but may be in the future. • OHA will publish a public health accountability metrics report annually, beginning in 2018. PUBLIC HEALTH DIVISION Office of the State Public Health Director 19

Public health accountability metrics * Aligns with CCO or early learning priority PUBLIC HEALTH DIVISION Office of the State Public Health Director 20

Guiding Principles for public health and health care collaboration • We will not see meaningful improvement in population health without cross-sector collaboration. • Direct services to individuals, including clinical interventions, are supported by the public health system’s focus on prevention; policy, systems and environmental change; and evidence-based strategies to improve population health. • Public health and health care must work together to ensure that every community member has access to high quality, culturally appropriate health care. This requires jointly developing and implementing solutions to address access and quality barriers. PUBLIC HEALTH DIVISION Office of the State Public Health Director 21

Columbia Pacific CCO framework for collaborating with local public health departments Priority: Increase Goal: minimum Immunizations <2y/O & Decrease increase of 5% for School Exclusions each county: SHARED CPCCO Work: (Clinical) Public Health Work • Advocacy • Education: provider & Outreach/homevisits • Pt Education member • Imms assessment • Promotion • Workflows • Patient Education • Data: Access, Actionable, • Messaging • Administration Timely • Advocacy • Reporting • Key community • Incentives • Promotion stakeholders • Analytics/QI • School exclusion • Barrier: Access Timelines and deadlines… Reporting PH/CPCCO Leads:

Discussion • How are the public health accountability metrics relevant to this committee’s work? • How can the Metrics and Scoring and PHAB committees work together to support infrastructure for collaborations between public health and the health care system? • What opportunities exist now to develop or build upon existing collaborations? PUBLIC HEALTH DIVISION Office of the State Public Health Director 23

Health Plan Quality Metrics Committee: Metrics & Scoring Recommendations for 2019 24

Health Plan Quality Metrics Committee Overview (1/2) • Established by SB 440 of 2015 • Charged with identifying health and outcome quality measures for CCOs (quality pool), and health benefit plans sold through the health insurance exchange or offered by PEBB or OEBB • Metrics & Scoring Committee is now a subcommittee of the HPQMC • The HPQMC is in the process of identifying a “master list” of measures from which Metrics & Scoring (and the exchange, PEBB, and OEBB) choose metrics for 2019+ • The ‘master list’ will be revisited by the HPQMC annually; process for revisiting is TBD 25

HPQMC Overview (2/2) • Legislation tasks HPQMC to “prioritize” measures that: – Utilize existing state and national measures – Are not prone to random variations based on the size of the denominator – Utilize existing data systems to the extent practicable – Can be meaningfully adopted for a minimum of three years – Use a common format in the collection of the data – Can be reported in a timely manner • Charter and legislation stipulate that the HPQMC must take into account the recommendations of the Metrics & Scoring Committee and differences in the populations served by CCOs and commercial insurers. • Metrics & Scoring Committee formal recommendations will be presented to the HPQMC in November 26

HPQMC Measure Selection Criteria Criteria for Individual Measures 1. Utilize existing state and national measures, including measures… a. that have been adopted or endorsed by other state or national organizations, and b. have a relevant state or national benchmark 2. Is statistically sound across the population size for which its use is recommended 3. Utilize existing data systems for reporting the measures 4. Present an opportunity for performance improvement 5. Can be meaningfully adopted for a minimum of three years 6. Use a common format in the collection of the data and facilitate the public reporting of the data 7. Can be reported in a timely manner and without significant delay 8. Promote increased value to providers, patients, and purchasers 27