Metrics Technical Advisory Workgroup March 24, 2016 PLEASE DO NOT PUT YOUR PHONE ON HOLD – IT IS BETTER IF YOU DROP OFF THE CALL AND REJOIN IF NEEDED 1
Today’s Agenda • Updates • School ‐ Based Dental Sealant Program Update • CCO Oregon Dental Metrics Workgroup Presentation • Measure Development • Health Equity Index • Food Insecurity Screening 2
TA Bank Consultant Webinars CCOs are invited to join TA Bank consultants to review opportunities for technical assistance. Consultants will share their areas of expertise and examples of prior TA bank projects. • Tuesday, March 29, 9 – 10 AM • Thursday, March 31, 3 ‐ 4 PM (behavioral health integration only) • Monday, April 4, 1 ‐ 2 PM • Thursday, April 7, 3 ‐ 4 PM (behavioral health integration only) Intended audience: QI coordinators, CAC coordinators, and other CCO staff leading work in TA Bank topic areas. http://www.oregon.gov/oha/Transformation ‐ Center/Pages/Technical ‐ Assistance ‐ Bank.aspx 3
Colorectal Cancer Screening TA Webinar series: Webinar #1: Screening Options for Colorectal Cancer – A Summary of the Evidence Behind Colonoscopy and Fecal Testing (FIT/FOBT) • April 13, 11 AM – Noon • https://attendee.gotowebinar.com/register/1068106650554228994 Individualized TA for CCOs: • First webinar will introduce TA available • Follow ‐ up calls with presenters (Gloria Coronado & Melinda Davis) 4
Year Three Data Submission • Year Three Clinical Quality Metrics data due April 1 st • OHA will complete initial review within 10 business days, and secondary review within 30 business days once initial review is complete. • If additional information is requested during review, CCOs will have 10 business days to respond / resubmit. 5
Year Four • OHA is working on guidance document and parameters for Year Four data submission. • Population threshold is increasing to 65%. • Seeking feedback about population threshold for new tobacco measure. Thoughts? • OHA will require at least one patient ‐ level data submission. 6
Dashboards & Data • CCO Metrics Dashboard • OHA will release March dashboard next week • Will continue in April, etc. • Also releasing ALERT IIS data in March • Opioid PIP Data • OHA provided Dec 2014 – Nov 2015 data last week • Skipping April due to analyst leave • Will resume in May, monthly thereafter 7
2016 Specification Update • Effective Contraceptive Use • Added new HCPCS codes J7297 and J7298 to numerator code table. • Developmental Screening • Clarified the period for the numerator and continuous enrollment are the 12 months preceding child’s birthday. http://www.oregon.gov/oha/analytics/Pages/CCO ‐ Baseline ‐ Data.aspx 8
SBIRT Update Please note: we will be updating the SBIRT guidance document to clarify that SBIRT services (CPT 99408 / 99409) can be documented with an E&M visit via modifier ‐ 25 by the same physician . The guidance document previously has stated that there is a separate provider requirement; this is no longer the case. 9
Tobacco Prevalence Specification Clarifications (1) • Previous discussion re: excluding members who do not have their smoking / tobacco use recorded. • New question: is this a numerator or denominator exclusion? • OHA proposes modifying the specifications to make this more clear. 10
Revised Measure Denominator: all patients (100) Numerator: of all patients, how many have cigarette smoking or tobacco use status recorded (80) Result: 80/100 = 80% Denominator: all patients who have smoking/tobacco use status recorded (80) Numerator: of those, how many are cigarette smokers (18) Result: 18/80 = 22.5%* Denominator: all patients who have smoking/tobacco use status recorded (80) Numerator: of those, how many are smokers (18) or tobacco users (2) Result: 20/80 = 25% 11
Tobacco Prevalence Specification Clarifications (2) • Should we only be looking at smoking / tobacco use status recorded at the most recent visit? • Alternately, recorded any time during the measurement year, even if not most recent visit? • Alternately, recorded in some period prior to the measurement year (e.g., 24 months to align with NQF 0028)? 12
Certification for School Dental Sealant Programs Oregon CCO Metrics Technical Advisory Workgroup March 24, 2016 13
SB 660 Mandatory Certification • Every Local School Dental Sealant Program must be certified before dental sealants can be provided in a school setting beginning for the 2016-17 school year. • A Rules Advisory Committee (RAC) assisted in drafting the rules language. • Final Administrative Rules, OAR 333-028, were effective January 29, 2016. The official language can be found online at: http://www.healthoregon.org/sealantcert − There are more requirements and new processes for certification than voluntary certification. 14
Summary of Certification Requirements • Coordinating representative must attend the one-time certification training provided by the OHA Oral Health Program. − 3 certification trainings being offered this spring. − Webinar will be conducted Friday, April 8 th for those programs that have already attended a certification training to go over the new processes and forms. • Annual clinical training must been provided to all providers rendering care within their scope of practice in a school setting. − Local sealant program may create their own training; or − Attend the OHA training being offered in August (date TBD) 15
Summary of Certification Requirements • Programs must contact CCOs operating in the community before they initially contact any school to offer services. – OHA will provide CCOs with a list of schools being served and targeted based on the application form. – CCOs will work with OHA to sort out duplication of services. – OHA will hold a webinar with key contacts from each CCO and provide them with a decision-making tool. • Medicaid encounters must be entered into the Medicaid system. • Elementary and middle schools with 40% or greater FRL must be targeted first. 16
Summary of Certification Requirements • Screening and dental sealant services, at a minimum, must be offered to all students with parental/guardian permission regardless of insurance status, race, ethnicity or socio-economic status. • Services must be offered, at a minimum, to elementary school students in 1 st and 2 nd grades or 2 nd and 3 rd grades. • Services must be offered, at a minimum, to middle school students in 6 th and 7 th grades or 7 th and 8 th grades. • A plan to increase parental/guardian permission return rates must be developed and implemented. 17
Summary of Certification Requirements • Dental equipment must be used on school grounds during school hours. • Parent/guardian permission forms must include a medical history. • Providers must use the four-handed technique to apply sealants in elementary schools. • Providers must use the two-handed technique using an Isolite or equivalent OHA approved device or the four-handed technique to apply sealants in middle schools. • Resin-based sealants must be applied. 18
Summary of Certification Requirements • Comply with all scope of practice laws as determined by the Oregon Board of Dentistry. • Comply with Oregon Board of Dentistry oral health screening guidelines. • Comply with infection control guidelines established in OAR 818- 012-0040. • Comply with HIPAA and FERPA requirements. • Classroom time must be respected, and demands placed on school staff must be limited. 19
Summary of Certification Requirements • Retention checks must be conducted at one year for quality assurance. • Annual data report must be submitted to the OHA Oral Health Program. − Aggregate-level data will be required for each school. • Certification logo must be included on all parent/guardian permission forms and written communication to schools, or the schools are provided with a letter by the OHA Oral Health Program regarding certification. 20
Certification Process • Local school dental sealant programs will apply for initial certification with the OHA Oral Health Program. – Certified – Provisionally Certified – Denied • Certification year is August 1 – July 31. • OHA Oral Health Program will conduct verification site visits. • Programs must apply for renewal certification no later than July 15 th of each year. – Data report must be submitted before applying. 21
Contacts Amy Umphlett Oral Health Operations & Policy Analyst (971) 673-1564 amy.m.umphlett@state.or.us Laurie Johnson School Oral Health Programs Coordinator (971) 673-0339 laurie.johnson@state.or.us 22
Metrics and Scoring TAG Meeting March 24, 2016 Sara Love, ND Matt Sinnott, MHA 23 23
CCO Oregon • Non-profit membership organization focusing on three key areas: – Collaboration – Research, Analysis, and Reporting – Policy Development 24 24
Workgroups • Dental • Integrated Behavioral Health Alliance of Oregon • Social Determinants of Health • Pharmacy 25 25
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