Metrics Technical Advisory Workgroup September 24, 2015 1
Ag Agenda enda Over Overvi view ew Updates Metrics & Scoring Committee debrief 2016 benchmarks 2016 challenge pool Tobacco measure Committee feedback Survey results Food Insecurity Screening measure Food Rx Program presentation Survey results Draft specifications 2
Updates 3
2015 Quality 2015 ality Pool ool 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% Total QP $167 million $128 million (final) (initial estimate) http://www.oregon.gov/oha/analytics/Pages/CCO ‐ Baseline ‐ Data.aspx 4
DHS DHS Cus Custody ody “Future Enrollments” exclusion for 2015. Future enrollment = a child appears on the weekly notification list because their eligibility status has changed in MMIS, but they are not yet enrolled in the CCO as of the weekly report notification date. Children with more than one week lag between notification date and effective enrollment date will be excluded from the measure. Upcoming transition to 834s for notification. Memo and supporting documentation to be released Tuesday, September 29 th with dashboard. 5
SBIR SBIRT e ‐ Specific Specificatio tions ns SBIRT sub ‐ workgroup is meeting on September 29 th. If any other CCOs are interested in the 2016 pilot for testing the EHR ‐ based measure specifications, please let us know at metrics.questions@state.or.us. OHA anticipates having the draft EHR ‐ based measure specifications available for review in October. 6
IC ICD ‐ 10 10 2015 metrics will include both ICD ‐ 9 and ICD ‐ 10 codes. OHA published preliminary ICD ‐ 9 – ICD ‐ 10 crosswalk in July. Included codes from HEDIS and OHA crosswalk exercises. OHA will publish final ICD ‐ 10 crosswalk no later than Wed, Sept 30 th . Encounters with ICD ‐ 9 coding post Oct 1 st will be pended in MMIS; CCOs will be able to correct them to ICD ‐ 10 at that point. Note all corrections will need to occur by March 31, 2016 for the encounter to meet the submission cut ‐ off date for incentive measures. Note some TPAs may have their own edit checks to address ICD ‐ 9 codes post October 1 st that may need to be resolved prior to any encounters reaching MMIS. 7
Upda Updated Specific Specifications tions OHA is currently updating the 2015 incentive measure specifications to include references to the final ICD ‐ 10 codes as well as other updates (e.g., future enrollments for DHS custody). OHA is finalizing the 2016 incentive measure specifications and intends to publish the first batch next week. OHA will notify TAG / CCOs when new and updated specifications are posted online. 8
Sep Septem ember ber Dashboar Dashboard Scheduled for release on Tuesday, September 29 th . Updated measurement period: May 2014 – April 2015. Two new slicers! Chronic conditions Substance use disorders Supplemental file: CY 2014 ECU with LARC breakout by CCO. 9
Metrics & Scoring Committee Debrief 10
2016 2016 Benchm Benchmark arks The Metrics & Scoring Committee met on Friday, September 19 th to select the 2016 benchmarks and 2016 challenge pool measures. The Committee selected benchmarks for all but 2 of the incentive measures (see handout). Colorectal cancer screening Tobacco prevalence The Committee agreed that the health equity “meta ‐ measure” concept needed more development prior to adoption for the challenge pool and kept the 2016 challenge pool measures the same as the 2015 measures. 11
2016 2016 Challeng Challenge Po Pool The Committee agreed that the health equity “meta ‐ measure” concept needed more development prior to adoption for the challenge pool, but kept it “on ‐ deck” for 2017. The Committee agreed to keep the 2016 challenge pool measures the same as the 2015 measures: Alcohol and drug misuse (SBIRT) Depression screening and follow up Developmental screening Diabetes HbA1c 12
Join Joint Comm Commit ittee ee Learning Learning Session Session Co ‐ meeting with Metrics & Scoring and Hospital Performance Metrics Advisory Committees. Scheduled October 30th 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. Tentative agenda Panel presentations followed by joint committee discussion, including: Lynnea Lindsey ‐ Pengelly of Trillium (discussing behavioral / physical integration) Chris Farentinos of Legacy Health (discussing Unity Center for Behavioral Health) Robin Henderson of St. Charles Health System 13
Mi Misc. Committee noted CCOs need to know about OHA’s definition of dental examinations and role of expanded practice dental hygienists. See June 22, 2015 letter from Dr. Bruce Austin providing guidance in the interpretation of the meaning of a “dental examination” and who can provide these exams. http://www.oregon.gov/oha/healthplan/Announcements/Dental%20examin ations%20under%20the%20OHP%20Recommended%20Periodicity%20Sched ule.pdf 14
Tobacco Measure (cont.) 15
Comm Commit ittee Feedback edback The Committee: considered the alternate proposal (which would change the minimum cessation benefit requirement from pass / fail to one of three, weighted components); agreed to keep the minimum cessation benefit requirement pass / fail; but asked TAG to consider a way to apply the weighted component concept to the rest of the measure, to phase in the emphasis on reducing prevalence. 16
Original iginal Al Alterna ernate Pr Proposal 2016 2017 2018 For meeting minimum cessation benefit requirement 40% 33% 25% For reporting EHR ‐ based prevalence data (meeting population 40% 60% 33% 66% 25% 75% thresholds, etc) For reducing prevalence (meeting benchmark / improvement target) 20% 33% 50% 17
Sur Survey Re Results At the August meeting, TAG members requested an online survey to provide additional feedback on components of the tobacco measure, including: Completing the cessation benefit survey in 2015 When the cessation benefit should be in place Recommendations about the 2016 benchmark Whether OHA should require CCOs to submit EHR data in 2015 25 individuals responded, with the majority (88%) representing CCOs. 18
Should OHA require CCOs to complete the cessation benefit survey in 2015? 12 11 10 9 8 6 4 2 2 0 Yes No Maybe N = 22 19
If OHA did not require CCOs to complete the cessation benefit survey in 2015, how likely would it be that your CCO would complete the survey anyway? 8 7 7 7 6 6 5 4 3 2 1 1 1 0 Very likely Somewhat likely Unlikely Very unlikely Unknown N = 22 20
2015 2015 Cessa Cessation tion Bene Benefit fit Sur Survey Staff Recommendation: OHA will not require CCOs to complete the cessation benefit survey in 2015. The survey will be available online for any CCOs that wish to complete it as a “dry run” in 2015 (survey to be finalized in October). OHA will answer questions / provide technical assistance related to the survey in 2015 as needed. 21
When should OHA field the cessation benefit survey for the 2016 incentive measure? 7 5 5 Prior to the start of the measurement Sometime during the measurement year After the close of the measurement year year N = 19 22
I think the minimum cessation benefit should be in place… 6 6 5 1 during the entire during the last quarter of the during the end of the other measurement year measurement year only measurement year only (e.g., last month or day) 23
2016 2016 pr proposal oposal fo for TA TAG discussion… discussion… To allow CCOs time to establish benefits in this first year of the measure, the 2016 measure will be based on cessation benefits that are in place as of July 1, 2016. Therefore, the cessation benefit survey needs to be fielded after July 1, 2016. OHA proposes fielding the 2016 cessation benefit survey in November – December 2016. The benefits in place and survey timing will be revisited for 2017. 24
Should OHA require CCOs to submit baseline data from EHRs in 2015 to inform benchmark and improvement target setting? 8 5 4 Yes No Maybe N = 17 25
2015 2015 da data pr proposal oposal fo for TA TAG discussion discussion Several CCOs / clinics that already have the ability to report on this measure (or something really close to the measure specifications) can volunteer to pull test data from their EHR and submit to OHA. OHA and CCOs will compare the EHR ‐ based data with the CAHPS and MBRFSS data on tobacco use. If CAHPS / MBRFSS / EHR ‐ based data is all fairly comparable, use CAHPS or MBRFSS data (or average of both?) just to set the 2016 improvement target. CCOs would not have to submit 2015 data from EHRs; this would allow time to develop EHR ‐ based reporting prior to 2016 submission; Would allow reasonable improvement target setting for the first year of this measure. If CAHPS / MBRFSS / EHR ‐ based data is not comparable, we are back where we started re: benchmark / improvement target setting. 26
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