October 26, 2018 1 Agenda Welcome, introductions, meeting goals - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP October 26, 2018 1

Agenda • Welcome, introductions, meeting goals and agenda overview • Public comment (9:45am) • Outline of Workgroup Final Report • Stakeholder input updates • Measurement strategy: Proposals for consideration and discussion • CCO attestation metric: Purpose and possibilities • Summary and next steps 2

Public Comment 3

Workgroup Final Report Outline A. Background on kindergarten readiness, context in Oregon, HAKR Workgroup formation and charge B. Workgroup process and products 1. Centering family voice 2. HAKR conceptual framework 3. HAKR measure criteria 4. Gaps and priority areas of interest within conceptual framework 5. Identified and assessed developed metrics 6. Identified new metrics 7. Prioritized metrics (visual of 13 metrics) 8. Developed recommendations for Metrics and Scoring Committee 4

Workgroup Final Report Outline C. Workgroup recommendations (1 of 3) 1. The role of the health system is to provide family-centered services and to work collaboratively with other sectors to ensure children are physically, socially, and emotionally healthy in preparation for kindergarten. The HAKR Technical Workgroup believes that a comprehensive kindergarten readiness plan includes an array of measures to track progress in all domains of kindergarten readiness, alongside sufficient resources and greater capacity for services and system-building. 5

Workgroup Final Report Outline C. Workgroup recommendations (2 of 3) 2. Measurement strategy proposal to Metrics and Scoring Committee, for inclusion in CCO incentive measure program • Strategy that includes more than one metric or a metric with multiple components • List the specific metric components and proposed timeline for adoption of various components • Outline key considerations in identifying a limited set of metric components in our proposed strategy 6

Workgroup Final Report Outline C. Workgroup recommendations (3 of 3) 3. Targeted recommendations for Health Plan Quality Metrics Committee, Oregon Health Policy Board, Health Equity Measures Workgroup, Oregon Health Authority, Governor’s Children’s Cabinet, Early Learning Division and others. • Measure concepts for future development • Alignment of measurement strategies with recommendations and work emerging from the Governor’s Children’s Cabinet, CCO 2.0, Early Learning Strategic Plan, and beyond 7

Stakeholder Input Received 8

Who Has Provided Input • Metrics and Scoring Committee • CCO Metrics Technical Advisory Group • Health Plan Quality Metrics Committee • Early Learning Hubs • Primary Care Providers • Families (in progress) • Others 9

Themes from Stakeholder Input Focus on the Caution against children who are recommending a not being served bundled metric well by the health with many metric system now Caution against components screening metrics Excitement about when we know metrics that focus on there are dental services, challenges with mental health capacity and services, and follow- access to services up to developmental screening 10

Themes from Stakeholder Input Connect recommendations to aligned work underway (CCO 2.0 priorities, CCO- and practice-level QI efforts, etc.) Summarize evidence Include at least one and analysis of how metric in set of recommendations recommendations will impact that can be kindergarten implemented in readiness 2020 11

Measurement Strategy Proposals: Workgroup Discussion 12

How We Will Be Discussing Proposals Today - Using the metrics visual and overview document as reference for key information about metrics under consideration - Using the worksheet to stay focused on our criteria - Flow for the discussion - Hear about CCO Attestation Metric concept and example components - Discuss 2 staff team proposals - Open up to additional proposals 13

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Factors To Use Today For Discussing Proposals for a Multi- Metric Strategy (see worksheet) HAKR Workgroup measure criteria if multiple metrics are included: 1. Set of metrics is parsimonious and limited in number of individual components. 2. Includes metrics which, in combination, measure the desired outcome by addressing the array of services that impact a child’s KR. 3. Includes metrics that utilize various data sources. 4. Includes measures with the most transformative potential to drive health system change and stimulate cross-sector collaboration. Additional factors HAKR Workgroup may consider in identifying components: • Includes a focus on addressing social-emotional health • Builds momentum for across-sector collaboration and integration within CCOs service lines (physical, behavioral and dental) • Set of metrics addresses different populations within 0-5 (e.g. not all metrics for 0-1 vs. 3-6) • Includes at least one metric that address the full population and a metric that focused on follow-up for children with specific needs • Balances urgency and current opportunity with desire for transformation (e.g. includes at least one metric that can be implemented in 2020) 16

How We Developed Staff Team Proposals - Reflected on priority areas of focus identified in early workgroup meetings, based on gaps in conceptual framework and family input - Reviewed assessment scores from when we assessed metrics using our HAKR workgroup measure criteria - Reflected on deep interest and workgroup discussions on how to create a focus on social-emotional health and development - Embedded input we have received from stakeholders - Given the policy and payment work needed, considered metric alignment with goals and objectives of CCO 2.0 - Considered gaps in M&S and HPQMC measure sets by domain and/or service line impacted 17

Proposal 1 18

Proposal 2 19

Workgroup Final Report Outline Let’s pause to talk about a CCO Attestation Metric (formerly known as Glidepath 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. 20

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8 ) C C O -Le v e l M e tric F o cu se d o n S o cia l-E m o tio n a l H e a lth * (e .g . C C O A tte sta tio n F o rm ). E xa m p le O p tio n s: A d d re ss p o licie s, p a ym e n ts a n d p ra ctice s fo r : a ) a sse ssin g a ch ild ’s so cia l e m o tio n a l h e a lth a n d fa m ily fa cto rs (in clu d in g SD O H ) im p a ctin g ch ild ’s so cia l-e m o tio n a l h e a lth ; b ) B e h a vio ra l h e a lth se rvice s (in clu d in g in te rn a l to p rim a ry ca re ); c) P a th w a ys to se rvice s fo r ch ild re n id e n tifie d w ith so cia l-e m o tio n a l h e a lth d e la ys . 22

Example Components of a CCO Attestation Metric • Examine and expand practices that address SE health , including family factors (i.e., SDOH) that impact a child’s SE health: – Convene partners to review and discuss “capacity mapping” findings and regional health complexity data. – Conduct cross-sector training on identifying delays in SE health. – Develop and implement specific pilots meant to address family- centered access of these services.  An example could include piloting enhanced assessment of a child’s social emotional health and/or family factors that impact social emotional development, and evaluating whether enhanced assessments result in increased access of behavioral health. For those that access behavioral health, assess the impact on child and family well-being. 23

Example Components of a CCO Attestation Metric • Assess and address capacity of behavioral health services for children 0-5 and their families, for example: – Map providers, services and capacity for serving children 0-5. – Examine claims data using the behavioral health utilization metric. – Identify pathways for primary care providers who serve children to refer parents identified with depression (i.e., during a well-child visit) to mental health services. 24

Example Components of a CCO Attestation Metric • Examine and address policies and payments for behavioral health services for children 0-5 and families: – Payment policies that limit access to services.  For example, those that limit access to integrated behavioral health services within primary care. – Payments for the assessment of SE delays in children, treatment for perinatal mood disorders in caregivers, or for the assessment of other family factors that impact SE health. 25

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 attest to the items  Determine how many items a CCO must attest to in order to receive the incentive payment, including whether there are any “must pass” items 26

Discussion 27

Summary and Next Steps 28

THANK YOU! Meeting Schedule November 5, 2018: 10 AM – 1 PM (Wilsonville) 29