Metrics & Scoring Committee October 19, 2018 HEALTH POLICY & ANALYTICS Office of Health Analytics
Today’s Agenda Welcome State of public health in Oregon and opportunities for incentive measures to aid in improvement HPQMC recommendations and strategic planning for measure set: • Discuss aims of incentive measure set • Move from broader aims to specific measures that meet that aim (including review of HPQMC menu set) Please note this meeting is being recorded. The recording will be made available on the Committee’s webpage: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-Scoring-Committee.aspx 2 2
Review September Minutes 3 3
Health Plan Quality Metrics Committee Update Met Thursday, 11 October • Discussed recommendations for Health Equity Measurement Workgroup • Discussed 2018-19 workplan (menu framework and measure criteria) • Received update on work of Health Aspects of Kindergarten Readiness Technical Workgroup Next meeting: Thursday, 8 November For committee information: http://www.oregon.gov/oha/analytics/Pages/Quality-Metrics-Committee.aspx 4 4
Measure Development Work 5 5
Health Aspects of Kindergarten Readiness • Sought feedback from TAG (27 September) and provided an update to the HPQMC on progress (11 October). • TAG noted concerns with using a multi-part bundle metric; value in rolling out different metrics at different time periods; and, value of metrics for 0-5 population given life course perspective. • Next meet 26 October and 5 November • Will incorporate input from Metrics & Scoring Committee, TAG, Early Learning Hubs, health care providers (including primary care), HPQMC, and other stakeholders • Will explore and refine measure recommendations • Present recommendations to Metrics & Scoring Committee on 16 November • The Metrics & Scoring Committee may then choose to carry some or all of these recommendations to the HPQMC in January 2019. 6
Measure Development • Obesity Metric Workgroup • Will provide substantive update to Metrics & Scoring Committee in November. • If Metrics & Scoring Committee supports proposal, would look to Metrics & Scoring Committee to ‘carry’ initial proposal to HPQMC in early 2020 for inclusion in 2021 HPQMC measures menu. • Additional components which require a longer development period (EHR-based), would be proposed in 2021, for inclusion on 2022 HPQMC measures menu. • Health Equity Measurement Workgroup • Co-chaired by Jon Collins and Leann Johnson, both of OHA. Will Brake from Metrics & Scoring Committee is a workgroup member. • First meeting end of October. • May propose measures for inclusion in 2020 HPQMC measures menu; potential for additional measures to be proposed in future years (i.e., 2021+ HPQMC menu). • As not created at request of Metrics & Scoring Committee, would not look to Metrics & Scoring Committee to carry proposals to HPQMC. 7
Standing Update – CCO 2.0 ~see straw model in packet; presented to OHPB at August meeting~ Anona Gund, OHA 8 8
Public testimony 9
Oregon’s health priorities: Recommendations to the Metrics and Scoring Committee on areas of unmet need Katrina Hedberg, MD, MPH Health Officer and State Epidemiologist Lisa Bui, MBA Quality Improvement Director October 19, 2018 OFFICE OF THE STATE PUBLIC HEALTH DIRECTOR Public Health Division
Purpose for today’s discussion • Highlight opportunities for improvement in state health priorities through CCO metrics 11
State Health Improvement Plan (SHIP) Priorities, 2015- 2019 • Reduce tobacco use • Slow the increase of obesity • Reduce the harms associated with alcohol and substance use • Improve oral health • Prevent deaths from suicide • Improve immunization rates • Protect the population from communicable disease 12
Currently in M&S Measurement Set: Prevent and Reduce Tobacco Use SHIP priority targets Decrease: • Cigarette smoking prevalence among youth • Other tobacco product )non-cigarette) use among youth • Cigarette smoking prevalence among adults CCO incentive metric • Cigarette smoking prevalence 13
Currently in M&S Measurement Set: Prevent and Reduce Obesity SHIP priority targets Decrease • Obesity among 2- to 5-year-olds • Obesity among youth • Obesity among adults • Diabetes among adults CCO incentive metric • Weight assessment and counseling in children and adolescents • Glide path workgroup started for an evidence-based metric 14
Currently in M&S Measurement Set: Improve oral health SHIP priority targets Decrease • Third graders with cavities in their permanent teeth • Adolescents who have ever had a cavity • Prevalence of older adults who have lost all their natural teeth CCO incentive metrics • Dental sealants on permanent molars for children • Oral evaluation for adults with diabetes 15
Currently in M&S Measurement Set: Improve immunization rates SHIP priority targets Increase: • Rate of 2-year-olds who are fully vaccinated • HPV vaccination series rate among 13- to 17-year-olds Seasonal flu vaccination rates in people ≥6 months of age • CCO incentive metric • Childhood immunization status (combo 2) Also on HPQMC list: Immunizations for adolescents (combo 2) 16
Gaps in Measurement: Reduce harms associated with alcohol and substance abuse SHIP priority targets Decrease • Prescription opioid mortality • Alcohol-related motor vehicle deaths CCO incentive metric • Screening, Brief Intervention and Referral to Treatment (SBIRT) for drugs and alcohol use 17
Opioid overdose mortality by year, Oregon 18
Alcohol-related deaths by year, Oregon 19
Alcohol-related deaths by age and sex; Oregon, 2016 20
Adult binge drinking by sex and year 21
Key strategies for reducing harms from alcohol and substance use disorders Population interventions 1. Increase the price of alcohol Health system interventions 1. Incentives for alcohol and substance use screening, treatment and prevention a. CCO incentive measure: screening and referral to treatment for alcohol or other substance use disorders (SBIRT) 2. Reduce high risk opioid prescribing a. Statewide PIP 3. Ensure access to evidence-based pain management 4. Ensure access to alcohol and substance use disorder treatment 22
Gaps in measurement: prevent deaths from suicide SHIP priority targets Decrease • Rate of suicide • Suicide attempts among 8th graders • Emergency department visits for suicide attempts CCO incentive metric • Depression screening and follow up plan HPQMC list • Follow up after hospitalization for mental illness 23
Suicide deaths by year, Oregon and US 24
Suicide deaths by age and sex, Oregon 25
Key strategies for suicide prevention Population interventions 1. Promote use of the National Suicide Prevention Lifeline 2. Ensure communities implement services and programs to promote safe and nurturing environments Health system interventions 1. Adopt incentive measures for suicide prevention a) CCO incentive measure: Depression screening and follow up plan b) State performance measure: Follow-up after hospitalization for mental illness 2. Establish universal screening for individuals at risk of suicide 26
Gaps in measurement: protect the population from communicable diseases SHIP priority targets Decrease: • Gonorrhea in women aged 15 – 44 years • HIV infections in Oregon residents • Hospital-onset Clostridium difficile infections • Infections caused by the Shiga toxin-producing Escherichia coli infections in children under 10 years CCO incentive metric None 27
HIV diagnoses and deaths, Oregon
Racial disparities in HCV outcomes, Oregon, 2009-2013 Chronic HCV Liver Cancer Deaths
Chlamydia rates 30
Key strategies for communicable disease control Population interventions 1. Reduce non-judicious antibiotic prescriptions Health system interventions 1. Adopt incentives for communicable disease control a) State performance measure: Percent of two year-olds who received recommended vaccines b) HPQMC measure: Chlamydia screening c) HPQMC developmental measure areas for HIV and hepatitis C screening 2. Promote use of expedited partner therapy by health care providers 31
Recommended Area of Focus State Health Improvement Plan (SHIP) Priorities, 2015-2019 • Reduce tobacco use • Slow the increase of obesity • Reduce the harms associated with alcohol and substance use • Improve oral health • Prevent deaths from suicide • Improve immunization rates • Protect the population from communicable disease 32
Alignment to Quality • Community Health Improvement Plans – Areas of Focus: Clinical, Public Health, Social, Equity • Transformation and Quality Strategy (TQS) – Key Components: Integration, Value Base Payment models, Oral Health, Utilization, Complaints and Grievance • Performance Improvement Projects – Statewide PIP • 2016-2019: Chronic Opioid use reduction strategies • 2019-2021: Appropriate Acute Prescribing of Opioids 33
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