HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP November 5, 2018 1
Agenda • Welcome, introductions, meeting goals and agenda overview • Public comment (10:10 am) • Affirm components of measurement strategy proposal specific to Metrics and Scoring Committee • Discuss future metrics proposal is driving toward • Discuss CCO Attestation metric • Finalize measurement strategy proposal • Next steps for final report and recommendations to Metrics and Scoring Committee • Workgroup reflections 2
Public Comment 3
Components of Measurement Strategy Proposal for Metrics and Scoring Committee 4
Discuss Future Metrics that the Proposal is Driving Tow ards Assess level of consensus on concept of driving towards bundled metric in the future 6
Preventive Care: Bundle/Composite Metric Approach What we’ve heard: PROS What we’ve heard: CONS • Concerns from M&S, TAG, and primary care • Felt to be more “transformational” than separate metrics providers about parsing multi-part bundle because all have to be addressed at once • Bundled metrics can be challenging for use in • Moves towards improved quality in the receipt of driving quality improvement because they have to different preventive care services be unbundled to identify where to focus QI efforts • Includes different types of health care (e.g. dental and primary care) • Could make the measure so burdensome that some CCOs might choose to focus their efforts • If a composite: Puts a focus on ensuring individual elsewhere children get all appropriate services (vs. a population level measure) • Depending on CCO/provider payment arrangements, incentive dollars could get split, meaning less transformation funds to providers • Bundle could require additional development of technical specifications 7
Additional consideration • Additional consideration: – The Metrics and Scoring Committee could choose to further incentivize the components of the strategy, even if they are not bundled in a three- part measure. Examples include: • Having a ‘bundled’ kindergarten readiness challenge pool requiring that a CCO meet X number of components to receive challenge pool dollars (**the “challenge pool” is a subset of incentive measures worth additional dollars if CCOs achieve them) • Inclusion of some or all of the components as a requirement for a CCO to earn 100% of the quality pool dollars for which it is eligible • Other possibilities as identified by the Metrics and Scoring Committee 8
CCO Attestation Metric Purpose is to drive CCOs to address complex system-level factors that impact the services that kids and families receive and how they receive them, and for which there may be payment or policy barriers that need to be addressed. Activities would build capacity within CCOs for enhanced services, integration of services, cross-sector collaboration, and measurement opportunities. Lays the foundation for future child- and/or parent-level metrics. 9
CCO-Level Metric Focused on Social-Emotional Health (e.g. CCO Attestation Form). Examine and expand screening for and identifying factors that impact SE health; Assess capacity and utilization of behavioral health services for children0-5 and their families; Address policies, and payment for Behavioral health services (within primary care and specialty behavioral health care) for children 0-5 and their families. 10
Components of a CCO Attestation Metric 1. Examine and expand screening for and identifying factors that impact SE health (including SDOH). 2. Assess capacity and utilization of behavioral health services for children 0-5 and their families. 3. Address policies and payment for behavioral health services (within primary care and specialty behavioral health care) for children 0-5 and their families. 11
Example Components of a CCO Attestation Metric 1. Examine and expand screening for and identifying factors that impact SE health (including SDOH). Examples: a) Conduct cross-sector training on identifying delays in social-emotional health that include follow-up pathways to address delays. b) Develop and implement specific pilots meant to address family-centered access of these services. • Pilot enhanced assessment of a child’s social emotional health and/or family factors that impact social emotional development, and evaluate whether enhanced assessments result in increased access of behavioral health services. • For those that access behavioral health services, assess the impact on child and family well-being. 12
Example Components of a CCO Attestation Metric 2. Assess capacity and utilization of behavioral health services for children 0-5 and their families. Examples: a) Assess the specific number of trained providers and their capacity to provide behavioral health services for children 0-5. This assessment should include: Map of providers and services available across the CCO region, including location, • languages in which these service are available, and race/ethnicity of the provider. Include behavioral health services within primary care and specialty mental health care. • Capacity of these providers (existing “case load” and potential for expansion). • Comparison of this capacity to the full population of children 0-5 in the CCO region, including how this capacity will meet the cultural and linguistic needs of families. b) Examine claims data, using behavioral health penetration metric (to be provided), for utilization of behavioral health services for children 0-5. Assess for disparities in the full population, by race and ethnicity, and by geography within the CCO region. 13
Example Components of a CCO Attestation Metric 3. Address policies and payment for behavioral health services (within primary care and specialty behavioral health care) for children 0-5 and their families. Examples: a) Address payment policies that limit access to services. For example, those that limit access to integrated behavioral health services within primary care including: • Prior authorization requirements for behavioral health services for children 0-5. • Prior-authorization requirements for behavioral health services in an integrated primary care clinic. • Requirements for specific diagnostic codes to be provided for behavioral health services based on the location of the provision of the service. 14
Workgroup Final Report Outline What would be the next steps for a CCO Attestation Metric, if included in our proposal to M&S? Develop and refine the items that would be included in the metric. Determine how CCOs would demonstrate/attest to the items. Determine scoring for the attestation metric. 15
Finalize Measurement Strategy Proposal for Metrics and Scoring Committee 16
Potential Proposal to Metrics and Scoring Committee 17
Potential Proposal to Metrics and Scoring Committee 18
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Discussion What do you want to convey to M&S about these three options? 20
Next Steps and Closing 21 21
Report and Recommendations • Finalize workgroup report: – Planning team will finish a draft of the workgroup report. – Workgroup will review report and provide feedback via survey. – Planning team will incorporate input into final report. • Present recommendations: – Planning team will present measurement strategy proposal to Metrics and Scoring Committee on November 16 th . Workgroup members are welcome to attend! – Additional recommendations will be delivered to targeted groups. 22
Workgroup Reflections 23
THANK YOU FOR ALL OF YOUR TIME, ENERGY, AND COMMITMENT TO OREGON’S CHILDREN! 24
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