Metrics & Scoring Committee September 18, 2015 1 Consent - PowerPoint PPT Presentation

Metrics & Scoring Committee September 18, 2015 1

Consent agenda *Approve June and July 2015 minutes 2

New Committee members Will Brake Thomas Potter Daniel Porter AllCare CCO Eugene Pediatrics Legacy Health CCO Representative At Large Measurement Expert 3

UPDATES 4

Update: Baseline Data In July and August, OHA released baseline (2014) data for the 2015 CCO incentive measures, including: • Effective contraceptive use • Dental sealants • Assessments for children in DHS custody • SBIRT for adolescents 5

Effective contraceptive use among members ages 18-50, 2014 Compared against 2015 benchmark 2015 Benchmark: 50.0% 40.7% 37.9% 36.8% 35.7% 35.6% 35.4% 35.5% 35.1% 35.1% 34.8% 34.8% 34.2% 33.2% 33.0% 32.9% 32.7% 31.7% 6

Effective contraceptive use among members ages 15-17, 2014 Compared against 2015 benchmark 2015 Benchmark: 50.0% 41.5% 37.1% 37.1% 35.9% 35.3% 34.4% 33.9% 31.6% 30.1% 28.7% 28.5% 28.2% 27.8% 25.6% 25.3% 24.6% 22.0% 7

Dental sealants on permanent molars for children, 2014 Compared against 2015 benchmark 2015 Benchmark: 20.0% 15.3% 14.1% 12.5% 12.4% 12.0% 11.7% 11.2% 10.8% 9.9% 6.6% 6.0% 5.6% 5.2% 4.9% 4.7% 4.7% 3.3% 8

Mental, Physical, and Dental Assessments for children in DHS custody, 2014 Compared against 2015 benchmark 2015 Benchmark: 90.0% 49.3% 36.6% 33.3% 33.3% 32.4% 31.8% 29.9% 28.3% 28.0% 27.9% 25.7% 24.7% 22.1% 21.4% 17.4% 17.6% 11.8% 9

SBIRT for members ages 12-17, 2014 Compared against 2015 benchmark 2015 Benchmark: 12.0% 6.9% 2.2% 2.0% 1.7% 1.7% 1.5% 1.2% 1.0% 1.0% 0.9% 0.8% 0.7% 0.5% 0.4% 0.3% 0.2% 0.2% 10

SBIRT for members ages 18+, 2014 Compared against 2015 benchmark 19.4% 15.1% 2015 Benchmark: 12.0% 10.8% 9.2% 8.8% 8.4% 7.6% 7.2% 6.4% 5.7% 5.6% 5.5% 5.0% 4.3% 3.7% 2.8% 0.8% 11

SBIRT for members ages 12+, 2014 Compared against 2015 benchmark 15.4% 13.5% 2015 Benchmark: 12.0% 9.3% 8.2% 7.7% 7.3% 6.5% 6.3% 5.7% 5.1% 4.9% 4.9% 4.1% 3.6% 3.3% 2.4% 0.7% 12

Update: 2015 Quality Pool OHA published the 2015 Quality Pool Reference Instructions and initial estimates of the 2015 quality pool by CCO on September 14 th . 2014 2015 Size 3% 4% $128 million $167 million Total QP (final) (initial estimate) 13

HOSPITAL TRANSFORMATION PERFORMANCE PROGRAM 14

HTPP Overview • HB 2216 (2013) established an incentive metrics program for diagnosis-related group (DRG) hospitals in Oregon. • The Hospital Metrics Advisory Committee was established to select outcome and quality measures and benchmarks for hospitals. www.oregon.gov/oha/analytics/Pages/Hospital-Performance- Metrics.aspx • The program is approved through OHA’s 1115 Medicaid waiver agreement with CMS for two years • Legislation in 2015 extended the program through 2019. 15 15

HTPP Funding • Funding is provided by the Hospital Provider Assessment • In first two years, equal to 1% of federal financial participation (capped at $150 million per year) • In subsequent years, equal to 0.5% of federal financial participation 16 16

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Future Collaboration & Shared Work: Joint Behavioral Health Learning Session • Co-meeting with Metrics & Scoring and Hospital Performance Metrics Advisory Committees. Scheduled October 30 th from 1 – 4 pm in Wilsonville. • • Goals:  That the two committees have a shared understanding of issues and work on behavioral health around the state  To begin conversations on a cross-committee vision for how incentive metrics support this work 18 18

Future Collaboration & Shared Work: Joint Behavioral Health Learning Session Tentative agenda • Panel presentations followed by joint committee discussion. • Confirmed presenters include  Lynnea Lindsey-Pengelly of Trillium CCO (discussing behavioral/physical health integration)  Chris Farentinos of Legacy Health (discussing Unity Center for Behavioral Health)  Robin Henderson of St. Charles Health System 19 19

Future Collaboration & Shared Work: What Next? 20 20

Public Testimony 21

2016 Benchmark Selection 22

Today • Measure by measure review. • Staff will present: • Current performance data • Current benchmark and improvement target • 2016 benchmark and improvement target option(s) • Staff recommendation • Committee will select 2016 benchmarks and improvement targets. 23

Guiding Principles • Adopt NCQA service year 2014 benchmarks reported in 2015 (“2015 national Medicaid”) for all measures where applicable. • Keep “Minnesota Method” for improvement targets. • Where actual values for NCQA 2014 benchmarks are not yet available, adopt conceptual benchmark (e.g., 2015 national Medicaid 75 th percentile). Committee can confirm benchmark selection at Nov meeting once values are available for review. 24

Adolescent well care visits Current (2014) 2014 Benchmark & 2015 Benchmark & Performance Target Target State: 57.6% 62.0% 2013 national Medicaid 75 th 2014 national Medicaid 75 th 32.0% percentile (admin data) percentile (admin data) High CCO: MN method with 3 MN method with 3 45.6% percentage point floor percentage point floor Low CCO: 19.4% 25

Adolescent well care visits (2) 2016 Benchmark & Target Option(s) 2015 national Medicaid 75 th percentile Pending NCQA (admin data only) 2015 national Medicaid 90 th percentile Pending NCQA (admin data only) Staff recommendation Benchmark: 2015 national Medicaid 75 th percentile. Improvement target: MN method with 3 percentage point floor. 26

Access to care (CAHPS) Current (2014) 2014 Benchmark & 2015 Benchmark & Performance Target Target State: 87.2% 88.0% 2013 national Medicaid 75 th 2014 national Medicaid 75 th 83.8% percentile; average of adult & percentile; average of adult child rates. & child rates. High CCO: 90.0% MN method with 2 MN method with 2 percentage point floor percentage point floor Low CCO: 79.3% 27

Access to care (CAHPS) (2) 2016 Benchmark & Target Option(s) 2015 national Medicaid 75 th percentile; 89.1% weighted average of adult & child rates. 2015 national Medicaid 90 th percentile; 90.6% weighted average of adult & child rates. Staff recommendation Benchmark: 2015 national Medicaid 75 th percentile. Improvement target: MN method with 2 percentage point floor. 28

Alcohol and substance misuse (SBIRT) Current (2014) Current (2014) 2014 Benchmark 2015 Benchmark & Performance Performance & Target Target (adults only) (w/adolescents) State: State: 13.0% 12.0% Committee Committee 7.3% 6.3% consensus. consensus; adjusted to include High CCO: High CCO: adolescents. MN method 19.8% 15.4% with 3 MN method with 3 percentage Low CCO: Low CCO: percentage point point floor 0.8% 0.7% floor 29

Alcohol and substance misuse (SBIRT) (2) 2016 Benchmark & Target Option(s) 12% Committee consensus. Increased % TBD Committee consensus, this would account for strong performance, methodology TBD. Staff recommendation Benchmark: 12.0%, and revisit for 2017 Improvement target: MN method with 3 percentage point floor. 30

Ambulatory care: emergency department utilization Current (2014) 2014 Benchmark & 2015 Benchmark & Performance Target Target State: 44.6/1,000 mm 39.4/1,000 mm 2013 national Medicaid 90 th 2014 national Medicaid 90 th 47.3/1,000mm percentile percentile. High CCO: MN method MN method 34.4/1,000mm Low CCO: 64.7/1,000mm 31

Ambulatory care: emergency department utilization (2) 2016 Benchmark & Target Option(s) 2015 national Medicaid 90 th percentile 39.8 / 1,000 mm Staff recommendation Benchmark: 2015 national Medicaid 90 th percentile Improvement target: MN method with 3 percent floor 32

Assessments for children in DHS custody Current (2014) Revised (2014) 2014 and 2015 Performance (Mental Performance (Mental & Benchmark & Target & Physical only) Physical & Dental) State: State: 90% 70% 27% Committee consensus MN method with 3 High CCO: High CCO: percentage point floor 100% 49.3% Low CCO: Low CCO: 60.8% 11.8% 33

Assessments for children in DHS custody 2016 Benchmark & Target Option(s) 90% Current benchmark Staff recommendation Benchmark: 90% Improvement target: MN method with 3 percent floor 34

Childhood immunization status Current (2014) 2014 Benchmark & 2015 Benchmark & Performance Target Target State: 82.0% 82.0% 2013 national Medicaid 75 th 2014 national Medicaid 75 th 67.8% percentile percentile. High CCO: N/A N/A 78.5% Low CCO: 58.2% 35

Childhood immunization status (2) 2016 Benchmark & Target Option(s) 2015 national Medicaid 75 th percentile (no change) 82.0% Staff recommendation Benchmark: 2015 national Medicaid 75 th percentile Improvement target: MN method with 3 percentage point floor 36

Colorectal cancer screening Current (2014) 2014 Benchmark & 2015 Benchmark & Performance Target Target State: 47.0% 47.0% 46.2% Committee consensus Committee consensus N/A MN method with 3 High CCO: percentage point floor 54.0% Low CCO: 29.7% 37