Metrics & Scoring Committee May 19, 2017 Consent Agenda Review - PowerPoint PPT Presentation

Metrics & Scoring Committee May 19, 2017

Consent Agenda  Review today’s agenda  Approve April minutes  Bylaw amendment (noting that voting by email is not allowed per public meetings law) 2

Health Plan Quality Metrics Committee • Second meeting occurred Thursday, May 11 o Jon Collins presented on the Metrics & Scoring Committee and CCO incentive measures • Scheduled to meet monthly (second Thursdays) through 2017 http://www.oregon.gov/oha/analytics/Pages/Qua lity-Metrics-Committee.aspx 3

Innovation Café Debrief 4

Kindergarten Readiness and Early Learning Hub Roles & Indicators OHA Metrics and Scoring Committee May 19, 2017 Liz Stuart, MPH, OHA Child Systems Collaboration Coordinator Tom George, Early Learning Division Research Analyst Helen Bellanca, MD, Associate Medical Director, Health Share of Oregon Place Your Logo Here - Align Center

Kindergarten Readiness Measurement • Conversations to date: – 2015: Child & Family Wellbeing Measures Workgroup discussed a possible KR metric; extensive work is needed to develop such a measure – September 2016: Metrics & Scoring heard from Helen Bellanca and Tim Rusk about KR concepts and measurement implications – October 2016: M&S presentation about measurement in the early learning system – Ongoing conversations in M&S, the TAG, and from the field (both health and early learning) regarding the need for referral and follow-up after developmental screening – Continuing challenges around collecting and sharing data across the health and early learning sectors Place Your Logo Here - Align Center 6

Early Learning System Goals  Coordinated and Aligned Systems (Early learning, K-12, Health, Human services, Business)  Ready for Kindergarten  Healthy, Stable, & Attached Families Place Your Logo Here - Align Center 7

Approaches to Measurement & Outcomes • 2015 – 17 biennium: “Traditional” (contract/accountability) approach DATA & Strategies Outcome Measurement & Activities & POLICY Challenges: -- Measuring coordination & collaboration is challenging -- Limited data systems, particularly for work that crosses sectors -- Developmental stages and local contexts vary across Hubs -- Population-level changes take more time than one contract cycle -- Moving metrics became focus instead of achieving outcomes Place Your Logo Here - Align Center 8

Approaches to Measurement & Outcomes • 2017 – 19 biennium: “Compact” approach Outcomes Strategies DATA & & POLICY & Activities Measurement Challenges: -- Allowing for local strategies but having common measures -- Data and data systems will take considerable time to develop -- Data not available for strong CQI -- Compact model not suited for accountability or incentives -- Convincing stakeholders they’re getting good ROI Place Your Logo Here - Align Center 9

Framework for ‘17-19 Hub Contract Cycle READY FOR KINDERGARTEN HUB ROLES INDICATORS/OUTCOMES 2.1 The role of the hub is to facilitate shared Early learning and K-12 professionals understanding and collaboration between early demonstrate increases in shared learning and K-12 partners regarding expectations language, activities, and expectations about the skills and abilities of children entering regarding kindergarten readiness. school. 2.2 The role of the hub is to work with partners to Family reports of comfort, engagement, facilitate family engagement activities across the and adequate preparation; improved community that promote seamless transitions into early registration; improved kindergarten and the family’s comfort and STRATEGIES kindergarten attendance engagement at their child’s school. & ACTIVITIES 2.3 The role of the hub is to work with partners to Children furthest from opportunity are coordinate identification of children & families from part of a timely and effective closed priority and focus populations, to recruit them for loop system from screening to services. early learning activities, enroll them in services, Increase in front line health provider and make timely referrals with smooth referrals to early learning resources transitions. Increased number of providers and 2.4 The role of the hub is to work with community SPARK programs. Increased self- partners to increase the percentage of children from reports of reading to children. Books in focus and priority populations who experience early Place Your Logo Here - Align Center the home. Improved KA scores; learning activities that prepare them for success in reduced KA disparities. school. 10

Framework for ‘17-19 Hub Contract Cycle HEALTHY, STABLE, AND ATTACHED FAMILIES HUB ROLES INDICATORS/OUTCOMES 3.1 The role of the hub is to work with early Reduced food insecurity. Increased learning programs and other partners to ensure stable housing. Reduced poverty/ children and families from focus and priority joblessness. Increased utilization of populations have access to family support financial supports, such as ERDC, services. Earned Income Tax Credits, etc. 3.2 The role of hub is to collaborate with the health sector to address the social determinants of health that lead to health and well-being for young STRATEGIES children and their families. & ACTIVITIES Reduced number of children 3.3 The role of the hub is to work with community experiencing abuse and neglect. partners to increase protective factors and reduce Reduced time out-of-home. Reduced childhood experiences of abuse or neglect. parental stress and maternal depression 3.4 The role of the hub is to work with community Increased well-child visits; dental partners to ensure children and families from focus visits/dental home; immunizations. and priority populations have access to medical, Partner reports of increased visits for Place Your Logo Here - Align Center dental, mental health and other health care services. services. 11

Points for Consideration • Use of Kindergarten Readiness as an overall principle for M&S to advance • Lack of agreement on definition of Kindergarten Readiness in Oregon • Current potential for alignment with Hub indicator system • Future potential for shared measurement with early learning system • Metrics that drive partnerships with non-health sectors • Developmental screening continues to be a key driver of cross- sector partnerships – build on this momentum Place Your Logo Here - Align Center 12

Points for Consideration • Kindergarten Readiness metric design: • Accountability metric: Crosses sectors, compels partnership, drives data sharing. Transformative, complex, and time-intensive. • Barriers: Funding not designed to cross sectors; data capacity in the early learning system • Measure the health aspects of KR: Feasible in the short term, does not comprehensively measure KR. Place Your Logo Here - Align Center 13

Questions/Comments Liz Stuart, MPH elizabeth.m.stuart@state.or.us (503) 891-9335 Tom George thomas.george@state.or.us (971) 304-4308 Helen Bellanca, MD helen@healthshareoregon.org Place Your Logo Here - Align Center 14

DISCUSSION Place Your Logo Here - Align Center 15

Metrics and Scoring 5/19/17 ECU H ELEN BELLA NCA , MD, MPH

Effective Contraception Use Metric Proportion of women at risk for unintended pregnancy who are using an effective method of contraception

Denominator: Women age 15-50 who are physiologically capable of pregnancy Numerator: Women with evidence of Tier 1 or 2 contraception during the measurement period (tubal ligation, IUD, implant, pills, patch, ring, shot, diaphragm)

Questions What is the intent of this measure? Do the current specifications address the intent? Are we having an impact? Should we consider a pregnancy intention screening metric instead?

The intent of this measure 1. Providing high quality primary care for women by improving contraception access ◦ Women are fertile for about 40 years, on average they are trying to avoid pregnancy for 35 of them ◦ 99% of sexually active women use contraception at some point in their lives ◦ Contraception is the most commonly needed primary care service for women (along with dental care!) ◦ At least 70% of women age 18-50 need contraception, only 36% of those on Medicaid got it in 2015 2. Preventing unintended pregnancy ◦ Having an unintended pregnancy means a woman is three times more likely to end up below the poverty line 2 years later ◦ Unintended pregnancies can derail education and job options, relationships and are associated with worse maternal and infant outcomes https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states https://www.ansirh.org/research/turnaway-study https://www.nap.edu/catalog/4903/the-best-intentions-unintended-pregnancy-and-the-well-being-of

http://www.guttmacher.org/pubs/FB-Unintended-Pregnancy-US.html

Primary care screenings identified as indicators of high quality care Cervical cancer screenings (Paps) Alcohol misuse (SBIRT) Breast cancer screenings (exams, mammography) Depression screening (PSQ-2 and 9) Diabetes screening (blood glucose and HgbA1c)

Lifetime risk of those conditions Percent of women who experience this condition in their lifetime Cervical cancer 0.7% Alcohol misuse 10% Breast cancer 12% Depression 27% Diabetes 35.5% Unintended pregnancy 48%