Metrics Technical Advisory Workgroup June 22, 2017 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 • Benchmarking Model • TAG July M&S Recommendations • Benchmarking (hypertension; any others) • ECU • Work plan for remainder of 2017 2
Updates 3
Transformation Center Technical Assistance • Tobacco Cessation Resource: Culturally Specific Tobacco Cessation Resources for Patients: www.oregon.gov/oha/HPA/CSI- • TC/Resources/Culturally%20Specific%20Tobacco%20Cessation%20Resources%20for%20Patients.docx • Tobacco Cessation Webinar: Tobacco Cessation Clinical Workflow • When: July 18, 1-2:30 p.m. • Register here: https://attendee.gotowebinar.com/register/1587067351965435394 • Questions? Contact Anona Gund at anona.e.gund@state.or.us. • Effective Contraceptive Use among Women at Risk of Unintended Pregnancy • Webinar- Supporting effective contraceptive use through understanding marginalized populations, shared • language and reproductive health When: Monday, June 26, 11-12 p.m. • Register here: https://attendee.gotowebinar.com/register/5571486385522417666 • Webinar - Providing quality contraceptive care throughout the lifespan • When: Thursday, June 29, 10-11 a.m. • Register here: https://attendee.gotowebinar.com/register/5601804318225412354 • Webinar - Using a clinic self-assessment tool for providing high-quality contraception services • When: Thursday, July 13, 12-1 p.m. • Register here: https://attendee.gotowebinar.com/register/1692788693975867394 • Webinar - Case Study of a Preconception Health Campaign in Southern Oregon • When: Thursday, July 20th 11-12 p.m. • Register here: https://attendee.gotowebinar.com/register/78526404410254082 • Questions? Contact Adrienne Mullock at adrienne.p.mullock@state.or.us. • 4
CCO Metrics Dashboards • CY 2016 final performance and payment amounts – today! • Notification to CCO CEOs • Posted to Business Objects w/email notification to TAG and Dashboard distribution list • CY 2016 public report – 6/27 • Next dashboard – planned for week of 7/3 • Rolling window: March 2016 – Feb 2017 • Measures updated to 2017 specs • 2017 improvement targets included 5
2017 EHR-Based Measures Update 6
Guidance on 2017 EHR-Based Measures • As in previous years, we will update the EHR-based Measures Reporting Guidance Documentation, with opportunity for comments before finalizing • Providing some updates this month, with more to come next month 7
Population Thresholds 2016 2017 2017 threshold projected revised Diabetes HbA1c poor 65% 75% 70% control Controlling high blood 65% 75% 70% pressure Depression screening 65% 75% 70% and follow-up Smoking prevalence 25% 50% 30% 8
Data Submission Approach • The Clinical Quality Metrics Registry (CQMR) will not be available for 2017 reporting • Anticipate go-live later in 2018, with availability for test submissions in advance of 2018 reporting deadlines • For 2017, basically same approach and templates as 2016 for data proposals and aggregated data submissions • For patient-level data, we anticipate requiring test submission of QRDA I report • Report from at least one practice per measure • Anticipate that QRDA I test report would be for standard measures only: diabetes HbA1c poor control, controlling high blood pressure, and depression screening and follow-up 9
Forecast for Future Reporting • CMS requires updated versions to be used in its quality programs for each measure year • Example screenshot from eCQI Resource Center for 2017 • For 2017, OHA encourages updating but continues to accept older versions of the CMS measure specs (e.g., CMS 122v4) • Seeking TAG feedback on a future requirement to use updated versions for reporting – timing? 10
Metrics & Scoring Committee • Met last Friday, 16 June • Reviewed TAG and staff recommendations • Selected initial 2018 incentive measure set (more next slides) • Next meeting is Friday, 21 July • Review 2016 report • Finalize 2018 measure set, including challenge pool • Begin selecting benchmarks for 2018 11
Metrics & Scoring Committee – June Decisions for 2018 Dental Sealants • No change to dental sealants measure specifications. • Instructed OHA staff to explore CCO Oregon proposal for adult bundled oral health measure related to diabetes for possible inclusion in the ‘on deck’ list for 2019 to be presented to the Health Plan Quality Metrics Committee (HPQMC). Developmental Screening – including follow-up component in measure • Instructed OHA staff to explore ‘follow-up’ measure for possible inclusion in future years. 12
Metrics & Scoring Committee – June Decisions for 2018 Follow-up after Hospitalization for Mental Illness • No change to measure specifications. Health Care Disparity – Mental Illness (equity measure) • No change to measure specifications (carve-out of other CCO population measure - numerator counts for physical health issues only, per HEDIS) . • Measure will not be bundled with broader measure (will be two distinct measures). 13
Metrics & Scoring Committee – June Decisions for 2018 CAHPS • Access measure is bundled for 2018 (separate benchmarks for adult and child measures; must hit benchmark/target for both to qualify for measure) Kindergarten readiness • 2018 challenge pool will focus on health aspects of kindergarten readiness; Committee will identify specific measures in July. 14
Metrics & Scoring Committee – June Decisions for 2018 Obesity At its May meeting the Committee asked staff to present any obesity metrics which would be ready to implement in 2018. Staff found two such measures from the meaningful use measure set: • BMI screening and follow-up for adults (https://ecqi.healthit.gov/ep/ecqms-2018-performance- period/preventive-care-and-screening-body-mass-index-bmi-screening- and) • Weight assessment & counseling for nutrition and physical activity for children & adolescents (https://ecqi.healthit.gov/ep/ecqms-2018- performance-period/weight-assessment-and-counseling-nutrition-and- physical-activity) • The Committee voted unanimously to add the child obesity metric above to the long list of possible 2018 measures upon which the Committee would vote to identify the 2018 measure set. • The Committee voted unanimously to add the adult obesity metric above to the “on deck” list for 2019 to be presented to the HPQMC. 15
Metrics & Scoring Committee – June Decisions for 2018 SBIRT • Given implementation concerns, Metrics & Scoring Committee has decided not to include SBIRT in the 2018 CCO incentive measure set • Intention is to pilot measure and bring it back for 2019 • OHA is seeking volunteers to participate in pilots – please email metrics.questions@state.or.us 16
Metrics & Scoring Committee – June Decisions for 2018 • The Committee voted to include those with an asterisk (overleaf) in the 2018 measure set • However, the 2018 incentive measure set will not be finalized until July, to allow additional time for reflection and discussion (the Committee called out Follow-up after hospitalization for mental illness, specifically) 17
Metrics & Scoring Committee – June Decisions for 2018 No Measure Votes 1 Child obesity - BMI, nutrition and activity counseling* 8 2 Diabetes HbA1c control* 8 3 ED utilization - general pop* 8 4 Smoking prevalence* 8 5 Childhood immunizations* 7 6 Colorectal cancer screening* 7 7 Dental sealants for children* 7 8 Developmental screening* 7 9 Equity measure - ED utilization amongst SPMI pop* 7 10 Assessments for children in foster care (physical, mental, dental)* 6 11 CAHPS - access to care (bundled)* 6 12 Controlling high blood pressure* 6 13 Depression screening* 6 14 Effective contraceptive use* 6 15 PCPCH* 6 16 Timely prenatal care* 6 17 Adolescent well-care visits* 5 18 Follow-up after hospitalization for mental illness 4 19 Preventive dental utilization for adults 3 20 CAHPS – satisfaction 2 21 CAHPS - shared decision-making 0 18
Questions? 19
Benchmarking model 20
Background • Last summer, the Metrics and Scoring Committee heard testimony calling attention to the fact that a CCO can be a top performer on a measure, yet still not qualify for payment if improvement from the previous year was negligible or went slightly backward. This will likely become more common as the program matures and initial large gains give way more steady high performance. CCOs who make a big leap in one year are essentially penalized in later years.\ • The Committee took note of this trend and would like to consider possible modifications for the 2018 measurement year and beyond. 21
Background 22
Background • At its December retreat, the Committee learned about benchmarking structures in other states (Massachusetts, Maryland, Washington, Iowa) and discussed options. • Committee was less concerned about example on previous slide, as performance overall still quite low. • Overall, Committee likes the simplicity of Oregon’s model: Recognition of both excellence and improvement. 23
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