Metrics & Scoring Committee December 14, 2018
Today’s Agenda Welcome Vote vice‐chair Updates Depression screening and follow‐up decisions for 2019 Update on 2019 quality pool amount Planning for 2020 measure set New ways of looking at data trends Finalize 2020 HPQMC recommendations Finalize 2020 work plan 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
Review November Minutes 3
Vice‐chair election 4
Health Plan Quality Metrics Committee Update Dec 13, 2018 Agenda Presentation: Clinical Quality Metrics Registry Discussion: Measure crosswalk to priorities, and measure gap assessment Discussion: Planning for OHPB retreat in January 2019 Next meeting: Jan 10, 2019 For committee information: http://www.oregon.gov/oha/analytics/Pages/Quality‐Metrics‐ Committee.aspx 5
Developmental Measures Updates 6
Obesity Measure Workgroup Update Current recommendation under review: A two‐part measure to address child and adult obesity (Ages 3 and up) • Component 1, Investments in multisector interventions – Clinical interventions (treatment) and multisector interventions (prevention) – community policy, systems, and environmental change strategies • Component 2, Document BMI and Referral to Intervention; follow up on referral – Reporting BMI change – EHR‐based Goal: Glide path to introduce Component 1/ Multisector Interventions in 2021 (year 1) and add BMI measurement change to the measure in 2023 (year 3) December 2018 Update • Technical work group for Component 1 met in December. Began drafting guidelines for multisector interventions and how to incentivize as a measure. • Technical work group for Component 2 will begin meeting in January 2019. 7
Health Equity Measurement Workgroup Update November Discussion: – Continuing to set the groundwork for future metric development. – Presentation on REALD and how it can be used for more granular measure disparity study – Overview of 2017 CCO incentive measures and available race/ethnicity data – Started the discussion on exploring qualitative measures – Discussion of SDOH measure development and intersection with Health Equity Measurement Next Meeting: December 18, 2018 ‐ Discussion: Readiness for measure recommendation in February ‐ Finalize statement of purpose For more information: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Health‐Equity‐Measurement‐ Workgroup.aspx 8
Public testimony 9
Significant Specification Changes by Measure Steward ‐ Longer Term Considerations • Precedent of rebasing when significant change to claims‐based measures • EHR options as outlined on next slide (Committee to decide if longer‐term decision, or immediate situation only) • HEDIS measure rebase using most recent specifications (is precedent) 10
Depression Screening Measure – Immediate Decisions for 2019 • Summary of changes • Measure steward changed measure such that a PHQ‐2 followed by a PHQ‐9 no longer counts as follow up ( see packet for 2019 specifications, PHQ‐2, and PHQ‐9) • Significant concerns raised by TAG and at public testimony at November Metrics & Scoring Committee meeting, 11
Depression Screening Measure – Immediate Decisions for 2019 • Immediate decision needed for 2019. Options include: A. No change B. Keep in 2019 measure set, but reduce benchmark C. Keep in 2019 measure set, but make reporting only for single year (option to include as requirement to receive 100% of quality pool) D. Suspend completely for 2019 **Keep but ‘rebase’ 2018 using updated specifications not included as an option due to significant technical issues in recalculating EHR measures using updated specifications 12
Update on 2019 Quality Pool Amount (see ‘2019 Quality Pool Amt’ document in packet) Chelsea Guest, Manager, OHA Actuarial Services 13
CCO metrics performance through a new lens Image source: https://www.digitaltrends.com/cool‐tech/best‐telescopes/
Reporting typically focuses on: Current‐year performance Individual CCOs Furthermore, benchmark sources vary from measure‐to‐measure. 15
The charts show CCO performance As a whole Over time Compared against a standard benchmark 16
Still not a comprehensive list! A weak telescope, if you will. • Outpatient utilization • Low birth weight • Any dental service • Oral evaluation for adults with diabetes • Access to dental service (CAHPS) • Potentially preventable hospital admissions: • Diabetes • Health status (CAHPS) • COPD or asthma in older adults • Diabetes care: Hba1c testing • Congestive heart failure • ED utilization among members with mental • Asthma in younger adults illness • Topical fluoride varnish • Early elective delivery • Weight assessment, nutrition, and activity counseling • Follow‐up after ED visit for mental illness 17
Moving toward interactive visuals Your input is valued 18
Moving toward interactive visuals Your input is valued 19
Time for a break 20
Finalize 2020 HPQMC Recommendations (to be presented in January) 1. Confirm move from food insecurity screening measure development, to broader social determinants of health 2. Decisions on health aspects of kindergarten readiness proposal and next steps 3. Other areas identified from October meeting 21
Measure Development Direction • At last meeting, heard rational for requesting that HPQMC prioritize developmental work on broader social determinants of health (which includes food insecurity), versus limiting to food insecurity • Supported by OPCA, Food Bank of Oregon, and OHA • Confirm Metrics & Scoring will take this to the HPQMC in January 22
HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP: SUMMARY OF FINAL RECOMMENDATIONS TO THE METRICS AND SCORING COMMITTEE 23
Why a Measurement Strategy The workgroup proposes a multi-year measurement strategy that aims to drive health system behavior change and investments that contribute to improved kindergarten readiness and cross-sector collaboration. • Kindergarten readiness is complex and the domains are interrelated. There is no one measure that captures all of the health aspects of kindergarten readiness. • The proposal builds on the existing CCO incentive metrics focused on children prenatal through age five. • The proposal balances the workgroup’s long-term vision for transformative work on kindergarten readiness with current momentum and sense of urgency. • It includes metrics that are feasible to implement within the next few years, and drives toward the development of future metrics necessary for progress toward kindergarten readiness. 24
Health Aspects of Kindergarten Readiness Measurement Strategy Proposal Preventive dental Follow-up to visits for children 1-5 developmental Health system years old screening behavior change, investments, and cross- Well-child visits for sector efforts children 3-6 years that contribute old to improved kindergarten CCO-level (Future) readiness attestation metric Child-level metric focused on social- focused on social- emotional health emotional health 25
Health Aspects of Kindergarten Readiness Measurement Strategy Proposal Health system behavior change, investments, and cross- sector efforts that contribute to improved kindergarten readiness 26
Implementation Recommendations There are multiple ways that the Metrics and Scoring Committee can choose to implement the proposed measurement strategy over the next few years . Below are the implementation recommendations preferred by the workgroup: 1) Adopt two metrics now for the 2020 CCO incentive measure set: • Well-child visits for children 3-6 years old • Preventive dental visits for children 1-5 years old (the Committee can choose to implement as a standalone metric, or combine with the current dental sealants metric for a more comprehensive children’s oral health metric) 2) Adopt a CCO-level attestation metric focused on children’s social-emotional health once specifications are finalized (i.e., for the 2021 or 2022 CCO incentive measure set). 3) Replace the existing developmental screening metric with a new follow-up to developmental screening metric in 2022 or 2023. 27
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