Metrics & Scoring Committee: Recommendations to Health Plan Quality Metrics Committee, 2019 Measure Set Will Brake, Committee Chair, AllCare Health Anna Jimenez, MD, Committee Vice-Chair, Family Care CCO November 9, 2017 HEALTH POLICY & ANALYTICS Office of Health Analytics
CCO Accountability to OHA CCO Incentive Measures • Annual assessment of CCO performance on selected measures. • Measures selected by public Metrics & Scoring Committee. • CCO performance tied to bonus $ • Compare annual performance against prior year (baseline), to see if CCO met benchmark or demonstrated certain amount of improvement Measure specifications and guidance documents online at: http://www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx 2
Previous Measure Selection Process 9 member committee, public Metrics & Scoring process, select measures and set Committee benchmarks Ad hoc workgroup with CCO representatives, operationalize Metrics Technical metric specifications, make Advisory Workgroup recommendations to Committee http://www.oregon.gov/oha/analytics/Pages/Metrics-Scoring-Committee.aspx and http://www.oregon.gov/oha/analytics/Pages/Metrics-Technical-Advisory-Group.aspx 3
Measure Selection in the Future: SB 440 (2015) • Established Health Plan Quality Metrics Committee (HPQMC) • Requires HPQMC to develop a menu of health outcome and quality measures for CCOs and plans offered by PEBB, OEBB, and the Insurance Exchange. • Any metrics used for these plans must be on the menu developed by the Committee. • Metrics & Scoring Committee now a subcommittee of the HPQMC. • Will affect measure selection beginning with 2019 metrics (which are selected during 2018) 4
Measure Selection in the Future: SB 440 (2015) • Charter and legislation stipulate that the measures selected by the HPQMC “must take into account the recommendations of the metrics and scoring subcommittee created in ORS 414.638 and the differences in the populations served by coordinated care organizations and by commercial insurers.” • Demographic data across plans in purview of HPQMC (PEBB, OEBB, Marketplace, Medicaid CCOs) show that over 70% of the lives impacted by the HPQMC metrics decisions are within Medicaid Payer Enrollees Percent OHP enrollees (July 2017) 1,050,937 71% PEBB enrollees (Aug. 2017) 139,074 9% OEBB enrollees (Aug. 2017) 138,523 9% Marketplace enrollees (2017) 155,430 10% TOTAL 1,483,964 100% 5
Priority Recommendations • Include all 17 measures already selected for the 2018 CCO incentive measure set in the 2019 HPQMC menu – Operational implications for 2018 CCO incentive program if any 2018 measures are dropped/modified from 2019 menu (prioritizing TA/QI efforts if measure will only include a particular population or be in use for one year, etc.) – Committee requests decisions that would impact any of the remaining 2018 CCO measure set (measures 9-17 in table in meeting materials), be made in November – If this not possible, we request that the HPQMC prioritize decisions on: Possible changes to the effective contraceptive use specifications, which include adolescents beginning in 2018 (#9); The weight assessment measure (#10 and its relation to the proposed development of an evidence-based obesity measure, B); and, The cigarette smoking prevalence measure (#13), and its relationship to NQF 0028, Tobacco Use Screening and Cessation Intervention, also under consideration by the HPQMC. 6
Additional Recommendations • That the 2019 HPQMC menu include six new measures that have already been through the Metrics and Scoring Committee’s established review process – While not included in previous incentive measure sets, the Committee would like them included in the menu so that the Committee would have the option of incentivizing them in future years • That the HPQMC adopt the Metrics & Scoring Committee’s “on deck” concept for developmental measures (formally identifying areas for measure development). This would include three areas: – Developing a measure of the health aspects of kindergarten readiness (work already endorsed by the HPQMC) – Sanctioning the development of evidence based obesity measures for adults and children – Developing measures of the follow-up part of the developmental screening measure. • See table in materials for detail on the rationale behind inclusion of each of the individual measures 7
Metrics & Scoring Committee Area of Interest: Addressing Obesity 8
Importance of Obesity Measurement – CCO Metrics Program • Obesity is the number two cause of preventable death in Oregon and nationally, second only to tobacco use • Addressing obesity is a statewide priority (e.g., slowing the increase in obesity is a priority area in Oregon’s State Health Improvement Plan). • Rates of obesity among adults on Medicaid are higher than for the general population, and also vary by race and ethnicity • Therefore, the Metrics and Scoring Committee would like to incentivize work in this area beginning in 2018
Importance of Obesity Measurement – CCO Metrics Program • Staff identified the following obesity-related measures for consideration, both of which are MIPS measures, so CCOs would be able to report in 2018: – NQF 0024 (children): Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents – NQF 0421 (adults): Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan • The Metrics and Scoring Committee ultimately chose the weight assessment (child) measure for inclusion in the 2018 CCO measure set, though we request that both be included in the 2019 HPQMC menu
Importance of Obesity Measurement – CCO Metrics Program • Metrics & Scoring heard evidence related to this specific metric from the CCO Health Evidence Review Commission’s Obesity Task Force, as well as population health data from the state public health officer (full slides are included FYI after this presentation) • High level take-aways for adults: – More is better – 12 visits is the minimum to see a clinically important difference – Combined diet and physical activity interventions likely to be the most effective – Primary care based interventions (low intensity interventions) may not be effective
Importance of Obesity Measurement – CCO Metrics Program • High level take-aways for children: – Clinical interventions (USPSTF) Intensive, multicomponent behavioral interventions (RCT evidence supports parent-only interventions are as, or more effective than parent-child or child only) High intensity is necessary: >26 hours or more Involvement of the parents is important Community-level interventions – “multisector” community, policy, systems and environmental change strategies
Importance of Obesity Measurement – CCO Metrics Program • Weight assessment, nutrition and physical activity counseling are important beyond any relationship to obesity – The measure requires nutrition and physical activity counseling for all children , not just those with BMIs outside normal range – Discussion of nutrition and physical activity is important to work that physicians can do to promote overall health and wellness (and being a healthy weight) generally Counseling about healthy diet, physical activity, and screen time is widely recommended.
Metrics & Scoring Proposal • Include weight assessment measure in 2019 menu as it relates to promoting health and well-being, and getting BMI reporting up to standard • Include evidence-based obesity measure development in “on deck / developmental list”. – Could include testing ICSI measures from Bailit Health, or development / testing of measure with all/some of following from evidence review: BMI reporting; Referral; Receipt of evidence-based interventions (i.e. > 26 hours for children, 12 encounters for adults); BMI improvement; Investment in multisector interventions – Development / testing could be conducted as in visual on next slide
Metrics & Scoring Proposal (developing evidence- based obesity metric / testing ICSI measures) Measure Development P4P • Evidence Presentation • Final testing • Measure Group Creation • Add to HPQMC • Obesity Metric(s) menu - plans can Developed incentivize in 2021 Measure Test • Obesity Metric(s) Tested • Obesity Metric(s) proposal discussion with M&S • Metric(s) discussion with HPQMC
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