Metrics & Scoring Committee December 16, 2016 Consent Agenda - PowerPoint PPT Presentation

Metrics & Scoring Committee December 16, 2016

Consent Agenda  Review agenda  Approve October minutes  Review written updates 2

2017 SBIRT Measure Request OHA has received a request to remove the claims-based SBIRT measure from the 2017 incentive measure set, given the magnitude of unavoidable coding changes and the lack of time to implement the changes prior to the start of the measurement year. Changes • Transition to ICD10 coding removed specific screening codes = no standalone ICD coding option for 2017. • CPT 99420 has been retired nationally effective Jan 1, 2017. Replacement codes exist, but there is not yet national consistency in how these codes should be applied to SBIRT. While OHA has selected a replacement code for the specifications, billing systems across the state would have to be reprogrammed immediately. 3

2017 SBIRT Measure Request OHA agrees with the rationale in the request and recommends the Metrics & Scoring Committee remove SBIRT as an incentive measure for 2017. During 2017, OHA will work with CCOs to operationalize an EHR-based version of the SBIRT measure so it can be reinstated as an incentive measure in the future. 4

Oral Health Access Framework: Report and Recommendations from Oregon’s Medicaid Advisory Committee 5

Presentation overview • Background and process for developing the Oral Health Access Framework • Oral Health Access Framework – definition, model, monitoring measures • Initial next steps 6

Oral Health Access Framework: Background and Process Dr. Bruce Austin, Dental Director, OHA

Oral health in a changing landscape 2015 • State Health Improvement Plan (2015-2019) 2013 • OHA Dental Director hired Medicaid expansion • Dental sealant metric Affordable Care Act Insurance adopted as of 2016 Marketplaces launch • Pediatric dental of one 10 Essential Health Benefits 2013 2014 2015 2016 2017 2014 2016 • Strategic Plan for Oral • Oral Health in Oregon: OHA Health in Oregon (2014- Dental Director report to the 2020) legislature (March) • Dental integrated into • Restored certain dental CCO model (July) benefits • Various strategic initiatives to address access, integration, coordination 8

The case for considering access • Evidence of disparity in utilization – 27% of OHP adults had a visit in past year (2015) VS 69% Oregonian adults with private dental benefits (2013) • Anecdotal evidence of access challenges from members, providers but limited grasp of data • Recent developments called for agency exploration of oral health access 1. Influx of new enrollees in OHP 2. Oral health integration as of July 2014 3. New CMS rules require network adequacy standards for dental providers (pediatric) 9

OHA ask to the MAC: May 2016 Develop a framework for defining and assessing access to oral health for OHP members. 1. What are the key factors that influence access to oral health care for OHP members? 2. What key data and information could OHA use to assess access to oral health services for OHP members? 10

Oral Health Work Group membership • 3 CCOs • 3 DCOs • 3 Providers (2 dentists, 1 hygienist) • 2 Consumer advocates • 3 Tribal representatives • 2 members of general public  No consumers applied to the work group – staff undertook separate consumer engagement effort. 11

Summary of consumer feedback “less stress & worry over how to pay for proper dental Importance of care” Dental “first teeth cleaning ever” Coverage “every dollar in my family counts” “I need… more availability when trying to make an Access to Care appointment…” & Barriers “[more] mobile dental care” “I want information in plain language…” “distance is a huge barrier” “OHP always gets the 8am appointment… it’s like they Patient want you to miss that appointment” Experience “oral health affects the rest of my health” Care “[there’s] not enough time to talk to my doctor about Coordination & this” Integration 12

Timeline May 25 : Request to MAC Summer : Oral Health Work Group meetings (3) Aug-Sept 15 : OHP consumer engagement Sept 21-23 : Work Group finalize recommendations Sept 22: Oral Health Work Group presentation to Oregon House Health Committee Sept 28 : MAC consider Work Group recommendations MAC memo to OHA: October 2016 13

Oral Health Access Framework Matt Sinnott, Willamette Dental Group, OHWG Co ‐ Chair

OHA/MAC Charge to Work Group • Standard Definition of Oral Health Access that provides a common language and understanding of oral health access in OHP for OHA and the broader stakeholder community. • Oral Health Access Framework Model that lays out the key factors and influencers that help or hinder oral health access in OHP. • Oral Health Access Monitoring Measures Dashboard that provides recommended priority measures to monitor key factors of access for OHP members. 15

Standard Definition of Oral Health Access in the Oregon Health Plan Oral health care access is achieved when people* are able to seek out and receive the right care, from the right provider, in the right place, at the right time. Oregon Health Plan members have better oral health care access when: Members, their caregivers, providers and plans understand the importance of oral health and are aware of dental benefits Members have the resources – such as transportation, child care, and accessible care sites – to seek regular oral health preventive services and appropriate treatment as needed Policies and systems are built to facilitate access, by funding oral health benefits, addressing administrative barriers, and incentivizing provider participation Health care providers of all types work together to coordinate oral health care and integrate care into a plan for overall health *Regardless of race, ethnicity, language spoken, culture, gender, age, disability status, income, education, or health. 16

OHP ORAL HEALTH CARE ACCESS FRAMEW ORK MODEL Personal/ Environm ental Potential/ Realized Access Factors Factors OHP MEMBER/POPULATION AVAI LABI LI TY ( POTENTI AL) • Oral health/ health needs • Provider supply & distribution • Member empowerment to  Characteristics (e.g. language seek care spoken, philosophy/ approach to  Oral health literacy care)  Access to  Participation in Medicaid transportation/ child care  Administrative factors (e.g.  Attitudes/ perceptions credentialing process) (including fear of dentist) • Integration of oral, physical and • Income/ assets behavioral health • Cultural background, including • Care coordination preferred language • Continuity of care • Disability status • Availability of transportation/ child Oral • Population health care • Social determinants of health • Characteristics of care site (e.g. Health Access (e.g. housing) hours, accessibility) Outcom es STRUCTURAL/ SYSTEMS OF CARE UTI LI ZATI ON ( REALI ZED) • Dental coverage (children & • Use of services, including adults) preventive and treatment as • Stability/ consistency of dental needed benefits • Equity (disparities in use of • Population health efforts to services) reduce disease burden • System navigation • Policy/ systems issues, for • Patient experience example: • Quality, patient-centered care (i.e.  Churn right care, right provider, right  Member assignment place, right time)  Referral requirements • Site of care (e.g. community-  Provider incentives based, emergency room)  Budgetary • Affordability of services 17 • Missed appointments

Process: recommending oral health access measures Work Group/MAC Work Group 1. Identify indicators 1. Compile discussion 1. Review, discuss of access and finalize 2. Crosswalk priority recommended 2. Prioritize top three factors and measures of oral “Availability” factors indicators with oral health care access and top three health care access to align with “utilization” factors measures priority factors (consider MAC recommended by 2. Select and guidance, next slide) local/national groups approve 15 3. Develop draft recommended measures dashboard measures Co ‐ chairs & Staff 18

Priority factors of access MAC guidance: Include factors that ‐ Availability (1) Support the Triple Aim: importance 1. Care Coordination of care coordination and patient 2. Coordination with experience as a critical components mental and physical of oral health care access in health (Integration) 3. Distribution of Medicaid Providers (2) Promote health equity and access Utilization for vulnerable and underserved 1. Patient-centered care populations within OHP (including 2. Quality of Services people with intellectual and physical 3. Patient experience disabilities, racial and ethnic minorities, pregnant women, children with special health care needs, and the aging) 19