September 11th, 2018 1 Agenda Welcome, introductions, meeting - PowerPoint PPT Presentation

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP September 11th, 2018 1

Agenda • Welcome, introductions, meeting goals and agenda overview • Where we’ve been and where we’re going: Progress and products • Measurement strategy: Key considerations, factors, and direction • Measurement strategy: Options for consideration and discussion • Other key topics for inclusion in report/recommendations • Summary and next steps 2

Comment Public 3

Workgroup Progress March – September 2018 • Reviewed background on health system transformation and CCO incentive measure program • Reviewed background on kindergarten readiness definitions and domains, and the OKA • Developed conceptual framework for Health Aspects of Kindergarten Readiness • Developed measure criteria • Prioritized areas within the conceptual framework for measure exploration • Reviewed and assessed Ready Metrics • Review and assessed Near Ready Metrics • Discussed options for using a combination of metrics • Discussed interest in New Metrics 4

HAKR Workgroup Products HAKR Final Report Conceptual Framework, Measure Criteria, Areas of Priority, Proposal to M&S, Areas for New Measure Development, Recommendations to HPQM, OHPB, Health Equity Measures Workgroup, HERC, etc. Recommendations to Health Plan Quality Metrics Committee (HPQM) • Endorsement of any new metrics proposed for Metrics and Scoring Proposal to adoption (required) • Metrics and Scoring (M&S) Recommendations for metrics that can be used by M&S and potentially other plans • Recommended measurement strategy (PEBB, OEBB) • Specific metric components of that Example: Consider inclusion of all metrics strategy HAKR workgroup rated highly. If on HPQMC • Proposed timeline for adoption of list, would add weight for use by others (e.g. various components for VBP, contracting, etc.) Current set N=19 Current measure list N=51 5

Key Considerations, Factors, and Direction 6 6

Key Consideration: CCO Incentive Metric Set Required Criteria – Reportable at the CCO level – Annual Reporting Criteria Considered Technical Measure Criteria – Evidence‐based and scientifically acceptable – Has a relevant benchmark – Not greatly influenced by patient case mix Program‐Specific Criteria – Consistent with goals of program and CCOs – Useable and relevant – Feasible to collect – Promotes increased value – Present an opportunity for quality improvement – Transformative potential – Sufficient denominator size Criteria Considered for the Measurement Set – Representative of array of services provided by program – Representative of diversity of patients served by program – Not unreasonably burdensome to payers or providers 7

Key Consideration: Limited Number of “Seats on the Plane” Significant Changes for 2019 Future Expansions Already Planned – 2020: Significant changes to two measures: 1. Health assessments for children in foster care and 2. Dental sealants measure – 2021: Significant changes to two measures: 1. Depression screening and 2. Postpartum care Potential Additional Changes – 2020: Measure(s) focused on increasing health equity – 2021+: Obesity measure – Future: Other developmental areas (food insecurity or SDOH screening, etc). 8

Additional Key Considerations for Development of a Measurement Strategy for Metrics and Scoring (M&S) • HAKR is a multi‐faceted concept, so it is not sufficient to recommend only one metric • Instead, a HAKR Measurement Strategy is needed that will incorporate multiple metrics over time • This Measurement Strategy specific to M&S needs to take into account what is already being measured , where there are gaps , and what is possible in the next few years  Leverage momentum and support from current members of Metrics and Scoring and Health Plan Quality Metrics 9

Direction for Development of Measurement Strategy for Metrics and Scoring (M&S) Given key considerations, strategy should include: A (Ready Metric(s)) + B (Glidepath Metric) + C (Near Ready Metric(s) to Develop) Given Metrics and Scoring (M&S) has a limited number of “seats” AND the measure list was increased for 2019 AND there are a number of other metrics being proposed, we will: • Recommend a limited number of metrics in the proposed measurement strategy that are feasible to adopt in the context of the total number of metrics on the list • Consider if specific metrics address population‐level OR service line gaps in the M&S measurement set and therefore may have a higher likelihood of adoption • Consider timing of when specific metrics are adopted, noting the importance of leveraging current level of support 10

Measurement Strategy is Like a Puzzle: Metrics are “Pieces” & Strategy is How They Fit in the Larger Puzzle and the Picture Created How Does it Fit in the Larger M&S Puzzle? = • Is the total number feasible to put in the set? • Does “the picture” of the pieces OR meaningfully address HAKR, fill gaps in M&S set, and highlight most 2020 M&S Measure Set 2021 M&S Measure Set 2022 (+) M&S Measure Set transformative areas? In what year(s) is it feasible to add the piece, given space in M&S set and what is addressed in the set? Is it feasible to develop these pieces? Is it feasible to get HPQM adoption of metrics for M&S use? 11

Options for Workgroup Consideration Options 12

Factors Used to Identify Individual Metric Components of the Measurement Strategy and to Assess the Set of Metrics Factors for considering an individual metric as a component of the strategy – HAKR measure criteria score (Workgroup assessment) – Fills gap in HAKR conceptual framework – Builds off input heard in discussions around new metrics, importance of focus on social‐emotional health – Fills gap in domains covered in the M&S measurement set – Fills gap in metrics for specific CCO services lines in the M&S measurement set – Level of development and resources needed (for Near Ready Metrics) – Likelihood of adoption by Health Plan Quality Metrics Factors for considering the “set of individual metrics” – Includes a focus on addressing social‐emotional health – HAKR Workgroup composite measure criteria: 1. Composite metric 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 13 cross‐sector collaboration.

In order to be successful, our measurement strategy should include:  A feasible total number of metrics  A staggered roll out, given inclusion of multiple metrics  An approach that makes it desirable for CCOs to adopt and focus on the topic 14

Current CCO Incentive Metrics, “Ready” Metrics, “Near Ready” Metrics (With Mean HAKR Criteria Scores for Metrics Assessed) 15 15

Current CCO Incentive Metrics: Population and Service Lines Addressed and Gaps 2019 CCO Incentive Measures Population CCO Service Line Prenatal Children Adults Physical‐ Prevention, Physical – Follow‐up Physical‐ Acute Behavioral Dental Service Provided Care Setting Screening 1. Adolescent well‐care visits X X 2. Emergency department utilization X X X 3. Assessments for children in DHS custody X X X X 4. Access to care (CAHPS) X X 5. Childhood immunization status X X 6. Cigarette smoking prevalence X 7. Colorectal cancer screening X 8. Controlling hypertension (EHR) X X 9. Dental sealants X X 10. Depression screening and follow‐up Teens X X (EHR) 11. Developmental screenings X X 12. Diabetes: Hba1c poor control X X 13. Disparity measure: ED utilization for X X X X members with Mental Illness 14. Drug and alcohol screening and referral Teens X X to treatment (SBIRT) X 15. Effective contraceptive use Teens X 16. Oral evaluation for adults with diabetes X 17. PCPCH X X X 18. Timeliness of Postpartum Care X X X 19. Weight assessment and nutritional X counseling in children and adolescents 16 TOTAL 1 12 12 12 1 2 2 2

Metrics Workgroup Could Consider for Components of a Measurement Strategy 17

Highlighting Social-Emotional Health: Opportunities and Challenges Opportunities • Heard excitement, enthusiasm and cross‐sector collaboration opportunities around the importance of social‐emotional health • There is energy around current social‐emotional screening by community‐based providers that wouldn’t be captured in a claims‐based measure Challenges • Measurement strategy needs to be feasible to implement in the next few years • Concern about the feasibility of developing a new recommendation , new standard of care , and new metric that could be: – Reviewed and approved by HPQMC – Reviewed and approved by M&S Opportunities • Social‐emotional health will be both a frame and a pillar in our recommendations • The Glidepath Metric (B) should include an explicit focus on social‐emotional health • Include recommendations in the HAKR final report related to social‐emotional health, with concrete steps for moving forward, including HERC examination of evidence on social‐emotional screening 18