Metrics & Scoring Committee May 17, 2019 Todays Agenda - PowerPoint PPT Presentation

Metrics & Scoring Committee May 17, 2019

Today’s Agenda  Welcome, review previous minutes, general updates  Individual measure review and assessment  Assessments for kids in DHS custody  Depression screening and follow-up  Colorectal cancer screening  Diabetes: HbA1c poor control  Controlling hypertension  Effective contraceptive use  CAHPS access to care  Cigarette smoking prevalence  Review findings from stakeholder survey 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 April Minutes 3

HPQMC Updates May 9 meeting highlights • Presentation on State Health Improvement Priorities • Presentation and discussion on inclusion of a Health Equity Measure in the 2020 measure menu set • Measure purpose: Meaningful access to health care services through the provision of certified and qualified interpreters. • The committee voted to not include this measure in the 2020 measure menu set. • No legislative updates • June 13 meeting: Welcome new members to the committee http://www.oregon.gov/oha/analytics/Pages/Quality-Metrics- Committee.aspx 4

Developmental Measures Health Aspects of Kindergarten Readiness • Social emotional health measure development Social Determinants of Health Health Equity Measure • Refined measure presented to HPQMC on 9 May Obesity • TAG providing feedback on revised specifications on 23 May 5

Committee Appointments • Under review by OHA leadership • Appointments begin August 2019 6

Public testimony 7

Individual Measure Review 8

Measure: Assessments for Children in DHS Custody - Committee Decision Recap • Current metric does not align with DHS policy or American Academy of Pediatrics (AAP) recommendations • AAP - see page 22: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care- america/Documents/Ch2_PP_Primary.pdf#Page=12 • Child Welfare Policy: OAR 413-015-0465 • Also note House Bill 3372 of 2017 requires CCOs to perform initial health assessments in accordance with the metric established by the Metrics and Scoring Committee. Current OHA CCO DHS OAR 413-015-0465 specs Component age timeline age timeline Physical health assessment 0-17 60 days 0-17 30 days Dental health assessment 1-17 60 days 1-17 30 days Mental health assessment 4-17 60 days 3 -17 60 days

Measure: Assessments for Children in DHS Custody • Overview: Percentage of children and adolescents who received timely mental, physical, and dental health assessments after entering DHS custody • Data Source: MMIS/DSSURS and ORKIDS • Equation: Depending upon age at CCO notification, identified children/adolescents must receive each of the components below within the specified timeframes: Component Age Timeline = Physical health assessment 0-17 30 days Dental health assessment 1-17 30 days Mental health assessment 3-17 60 days Identified children/adolescents 0 – 17 years of age as of the first date of DHS/OHA notification and who remained in custody for at least 60 days. Include only those about whom DHS/OHA notified the CCO in the weekly file • 10

Measure: Assessments for Children in DHS Custody • Continuous Enrollment Criteria: • All children continuously enrolled with the notified CCO (with CCOA coverage) from the date of CCO notification through 60 days after with no gaps in coverage. • Children with delayed start of enrollment to the notified CCO for up to 7 days are only included if they are also numerator compliant (the CCO would receive credit on the metric). • Children with a delayed enrollment and who did NOT complete all required assessments are excluded. • NB: • To allow time for follow-up, children are included in the denominator if the CCO is notified of enrollment from November 1 of the year prior to the measurement year, to October 31 of the measurement year. • There are numerous exclusions from the measure, including: • Children on runaway status • The CCO does not receive notification from OHA that the child is in DHS custody (even if DHS notifies the CCO) • The CCO does not receive timely notification from OHA 11

Measure: Assessments for Children in DHS Custody preliminary data Statewide median days to completed assessment (preliminary data)* Number of Physical Dental Mental Custody notification period Children Health - Days Health - Days Health - Days 11/1/2017 - 10/30/2018 (2018 measurement year) 1,662 -3 24 16 5/1/2017 - 4/30/2018** 1,884 0 28 16 4/1/2017 - 1/31/2018 1,426 0 28 15 *Only included case that completed all required assessments using CCO specs ** Starting in 2018Q2 reporting period, a full year intake period is used (instead of 10 months) 12

Measure: Assessments for Children in DHS Custody preliminary data Measure: Assessments for Children in DHS Custody preliminary data Rate Comparison – 2018 versus 2020 Specifications (using AAP/DHS policy) 2018 Specifications 2020 Specifications Number of Physical Dental MH All Physical Dental MH All Custody notification period Children Only Only Only required Only Only Only required 11/1/2017 - 10/30/2018 (2018 measurement year) 1,932 95.3% 88.4% 93.6% 86.0% 84.6% 52.2% 91.4% 54.3% 5/1/2017 - 4/30/2018** 2,230 94.6% 88.0% 92.4% 84.5% 83.4% 51.0% 89.5% 52.5% 4/1/2017 - 1/31/2018 1,734 94.4% 85.9% 91.9% 82.2% 82.9% 48.3% 89.1% 49.4% ** Starting in 2018Q2 reporting period, a full year intake period is used (instead of 10-months) 13

Work Group of DHS and CCO Representatives Meeting Monthly Since November, 2018 • Discussed work flows on placement and information • Talked about Shelter Orders, Placement, Federal Review Specialists and how Medical Assistant Specialists do CCO enrollment • Some discussion around patient portals and case management tools and dummy placement codes • Discussed barriers and challenges • DHS automatic enrollment into CCO-A—Shelly Watts 14

New process idea….What Staff Can “Control” 15

Proposed Plan- Operationalize the Work Plan • Start 30-day clock on Medicaid Notification to CCO Enrollment (as now) • Use 834 forms or other inter-agency aids to have informal communication between groups • Medical Assistant Specialist will be contact since case worker usually out • Roles and responsibilities of each person is operationally documented • CCOs have identified contacts who form relationship with each Medical Assistant Specialist • Communication system becomes independent from paperwork entry or formal metric • Status of each newly enrolled child is updated as it changes until appointments fulfilled-CCO notify back to DHS date when completed if possible • Sign off by top leadership to support this plan so there is agency commitment • Further process changes will be necessary and potential tools for interagency secure communication may be needed (exploring for future) 16

Metric Officially Calculated • Incentive metric is officially aligned with DHS as much as operationally possible because of the control of information exchange related to the medical, oral and mental health focus • The coordination “on the ground” is managed by person-to-person contact and networking • More support will be requested for strengthening these “people networks” from Transformation Center and Innovator Agents who can be very helpful with connecting people to Field Offices • The 834 Enrollment Forms will give 1-2 week head start and more information exchange with DHS partners on the ground • Official metric start time will remain notification • Group will continue to meet regarding vocabulary and status for foster children “trial reunification” and other terms 17

Measure: Depression Screening and Follow-up • Overview: Percentage of adult patients (ages 18 and older) who had appropriate screening and follow-up planning for major depression • Data Source: EHR; electronic Clinical Quality Measure (eCQM) • Equation: Patients screened for depression on the date of the encounter, using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screen = Patients aged 12 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period. • Eligible encounters are identified through the Depression Screening Encounter Codes Grouping Value Set (2.16.840.1.113883.3.600.1916). 18

Measure: Depression Screening and Follow-up • Continuous Enrollment Criteria: None. The “eligible as of the last date of the reporting period” rule may be used to identify beneficiaries to be included in the measure. • NB: • Beginning in 2019, the measure steward, CMS, no longer counts numerator credit for a PHQ-2 screen followed by a PHQ-9 screen (where PHQ-9 is treated as follow-up to a positive PHQ-2). • Beginning in 2020 (CMS2v9), the measure steward, CMS, will allow the screening to be administered up to 14 days before the date of the encounter, for example, through a patient portal in advance of the appointment. 19

Measure: Depression Screening and Follow-up 20