Metrics & Scoring Committee January 20, 2017 Consent Agenda - PowerPoint PPT Presentation

Metrics & Scoring Committee January 20, 2017

Consent Agenda  Review agenda  Approve December minutes  PCPCH final decision 2

Review workplan for 2018 measure selection 3

Public testimony

Equity Measure (continued) 5

December Recap • Committee reviewed CCO feedback on which populations and measures they might select – Measures chosen most frequently include developmental screening, adolescent well care visits, effective contraceptive use, colorectal cancer screening, and emergency department utilization. – Populations chosen most frequently include age, race/ethnicity, geography, disability and/or mental health / severe and persistent mental illness diagnoses. • Committee discussed – Whether CCOs should be required to pick a racial/ethnic population – Whether age met the Committee’s intent for the measure – Whether white populations met the Committee’s intent for the measure – Whether a reporting only / process measure was possible • Request for staff proposal 6

Staff Recommendation OHA recommends that the Committee only adopt one equity measure for 2018 (as there are multiple topics also under discussion for potential 2018 measures). Based on previous Committee discussion, workgroup discussion over the past year, measure feasibility, and recent performance, OHA recommends the Committee adopt one of two options. 7

Staff Recommendation: Option 1 Select ED utilization as the equity measure for all CCOs . Each CCO must chose two populations experiencing disparities to focus on. ED utilization is high impact, has sufficiently large denominator for all CCOs, and shows disparities across multiple populations (including race/ethnicity, gender, language, urban/rural, people with SPMI, etc.) Benefits Limitations   Sufficient denominator size for all CCOs Oregon already doing well on ED utilization (approaching 90 th percentile for  Utilizes existing data and reporting / can be monitored throughout the year Medicaid population as a whole), so focus  Quality improvement efforts likely multi- may be better put elsewhere. faceted (e.g., access, avoidable ED, care coordination)  Simple to explain  While Oregon overall is doing well on ED utilization, certain populations are being left behind. 8

Option 1a: Select population for all CCOs (OHA top recommendation) ED utilization for individuals experiencing SPMI ED utilization among members with SPMI compared with members overall in each CCO (mid-2016) 155 142 122 120 117 113 109 109 106 105 104 97 95 89 84 83 64 60 53 50 48 47 46 45 45 41 41 39 39 39 33 31 9

Option 1b: Require one of two populations to be racial / ethnic group • Disparities by race/ethnicity are not as great as SPMI for ED utilization • Decision needed whether CCOs can select white population. 10

Staff Recommendation: Option 2 Select a specific population for all CCOs CCOs can select any of the incentive measures for which there is available data and sufficient denominator size (n>30) for which this population is experiencing a disparity. Benefits Limitations   Sufficient denominator size for all CCOs Focus on one population but multiple  Historically disadvantaged population measures could result in confusion, or lack  Multiple measures to select from of coordination in efforts to reach  Utilizes existing data population, particularly in areas where  Focus on one population could result in CCOs share geography.  significant improvements across multiple CCOs will need to select measure and areas write proposal.  Simple to explain 11

Option 2 Option 2a: select members with disability as the specific population Additional benefits Additional limitations   Eligibility codes apply to both children Reporting relies on Medicaid eligibility and adults, further increasing the codes; self-reporting is not included, number of applicable measures resulting in an undercount of all members with disability. Option 2b: select members with SPMI as the specific population Additional benefits Additional limitations  SPMI diagnosis apples to adults only, limiting the number of measures from which CCOs could choose. 12

Option 2 continued Staff does not recommend selecting a racial/ethnic group as the specific population for the equity measure. • Denominators are too small for many group / measures. • While all CCOs have at least one measure reportable by each population (with the exception of Hawaiian / Pacific Islander), the measure for which the CCO might have sufficient population (n>30) may not be an area where that population is experiencing a disparity. • This approach would back CCOs into working on a measure for a population that may not show disparity, or where greater disparities exist among other populations. 13

Discussion 14

PATIENT EXPERIENCE MEASURES

What is patient experience? The full range of patients’ interactions with the health care system, from scheduling appointments to interactions with their providers, to the course of treatment, including whether these interactions meet patient needs and goals – FamiliesUSA Quality Measurement Brief The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care – The Beryl Institute The range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities. As an intergral component of health care quality, patient experience includes several aspects of health care delivery that patients value highly when they seek and receive care, such as getting timely appointments, easy access to information, and good communication with providers - AHRQ

Why include patient experience? • Key element of HHS National Quality Strategy; CMS is mandated to include patient experience in programs, including ACOs, hospital value-based purchasing, etc…and CMS Access Monitoring Plan requires CAHPS data. • Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety, and lower utilization. • Measuring patient experience complements other quality measures by generating information about aspects of care for which patients are the best / only source. • Patient experience measures provide rigorous, validated alternatives to subjective reviews (e.g., ratemydoc, Yelp)

Common concerns • Patient feedback is not credible because patients lack formal medical training and “satisfaction” = “happiness”, which is highly subjective to factors unrelated to care provided. • Patient experience measures could be confounded by factors that are not directly associated with quality processes. • Patient experience measures could reflect fulfillment of patients’ immediate desires, regardless of care experience / benefit, which reduces the validity of their perspective.

How to measure patient experience? • CAHPS surveys are widely regarded as the national standard for collecting and reporting patient experience information. • Existing CAHPS surveys for health plans, clinicians, dental, home health care, hospice, hospitals, surgical care, and more. CAHPS is under constant research to improve it and new CAHPS surveys for ACOs, emergency departments and other settings are under development. • CAHPS survey questions often combined into composite measures: – Summarizes large amounts of information and makes it easier for people to review and compare (fewer points of comparison) – Recommended as primary reporting strategy

How do we decide which CAHPS measures to use? High correlation High correlation Can compare state performance Low priority High priority to national benchmarks 0.8 A3 S1 S2 Can compare performance across health plans or for specific A4 H A1 Correlation with Health A2 populations to identify gaps 0.4 Can use CAHPS results to Care Rating develop a priority matrix to C1 C4 identify gaps and strengths, based on correlation between the C2 C3 Rating of Health Care measure and other composites. 0.0 Low correlation Low correlation Low priority High priority

Current CAHPS measures Access to Care Satisfaction with Care (Health plan customer service treated (Members received appointments and member with courtesy and respect and care when they needed them) provided needed information)

Current CAHPS measures: Access to Care Q4: Whether the respondent got urgent care for illness / injury as soon as they needed Q6: Whether the respondent got non-urgent appointments as soon as they needed Adult Excellent / Fair / Very Good / Poor National Statewide Male Female CCO Range Good Health Health Comparison Status Status Q4 84% 87% 79% 87% 83% 75 – 91% 84% Q6 77% 77% 78% 76% 78% 72 – 84% 78% Average 80.7% 82.2% 78.3% 81.6% 80.5% 75.1 – 85.1% 80% Child Excellent / Fair / Poor Very Good / Chronic No Chronic National Statewide Health CCO Range Good Health Conditions Conditions Comparison Status Status Q4 92% 93% 83% 93% 91% 86 – 97% 91% Q6 84% 85% 72% 84% 85% 80 – 93% 88% Average 88.1% 89.1% 77.4% 88.5% 87.9% 83.9 – 94.8% 90%