Metrics Technical Advisory Workgroup

November 16, 2017

PLEASE DO NOT PUT YOUR PHONE ON HOLD – IT IS BETTER IF YOU

DROP OFF THE CALL AND REJOIN IF NEEDED

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Today’s Agenda

• Updates• EHR-sourced measures• Review 2017 smoking cessation survey• TAG input on CCO metric guidance documents• 2018 TAG work plan

Please note this meeting is being recorded. The recording will be made available on the CCO TAG webpage: http://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-

Technical-Advisory-Group.aspx

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Updates

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Transformation Center Technical AssistanceED-MI metric: Technical assistance webinar series

• Resources and Innovative Interventions in Medicaid for Managing Patient Pain• November 14, 9-10 a.m.; Register here: attendee.gotowebinar.com/register/6855916080380610563

• Prior webinar recordings available on the Transformation Center website: www.oregon.gov/oha/HPA/CSI-TC/Pages/Resources-Metric.aspx

Adolescent well-care visits: • TA Needs Assessment calls: A focus on 18-21 year olds. As a follow up to past TA on the AWV metric, the TC is

inviting CCO staff to participate in 2 needs assessment calls focusing on the older youth population: • December 1, 1-2 p.m. Conference line: 866-390-1828 code 4628003; Register here:

attendee.gotowebinar.com/register/3646477923454330882• December 4, 9-10 a.m. Conference line: 866-390-1828 code 4628003; Register here:

attendee.gotowebinar.com/register/3038851514061675778

PCPCH technical assistance• CCO needs assessment calls: The OHA Transformation Center is looking for input from CCO staff to help shape

future technical assistance opportunities for CCOs related to PCPCHs. During the webinar PCPCH program staff will facilitate a discussion to determine how the Transformation Center can help CCOs add PCPCHs to their network and provide support to already recognized PCPCHs.

- Tuesday, November 21, 9-10 a.m. Conference line: 877-336-1829; code: 3100151; Register here: https://attendee.gotowebinar.com/register/3230615138015726850

- Tuesday, November 28, 2-3 p.m. Conference line: 877-336-1829; code: 3100151; Register here: https://attendee.gotowebinar.com/register/9092708660503486722

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CCO Metrics Dashboards

• Previous dashboard released October 25• Rolling window: July 2016 – June 2017• Immunization measure member-level results

• Next dashboard – November 29• Rolling window: August 2016 – July 2017• Q3 PCPCH

• DHS Custody

• ALERT Data / Immunization measure survey

EHR SBIRT Pilot Update

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Metrics & Scoring Committee• Met 20 October and presented 2019 recommendations to Health Plan Quality Metrics Committee on 9

November (see meeting materials: MS recommendations for HPQMC_2019 document)• Heard presentations on the obesity measure, the tobacco prevalence measure, and finalized recommendations to

Health Plan Quality Metrics Committee (HPQMC) for 2019 menu set• Recommendation was to include all measures from 2018 PLUS six additional measures (below) and proposing a glide

path to an evidence-based obesity measure (where 2018 weight assessment measure used to ensure BMI recorded across the state, and also noting this measure’s utility beyond obesity, but in terms of general health promotion):

• Dental care for adults with diabetes • Preventive dental services utilization for adults • Coordination of care (CAHPS)

• BMI screening and follow-up for adults • EHR-based SBIRT • Food insecurity screening

• Also recommending that HPQMC include three measures in its own “on deck” list for development and inclusion in the HPQMC menu in future years:

• Kindergarten readiness (HPQMC is already sponsoring a workgroup in this area, focusing on the health aspects of kindergarten readiness)

• Developmental screening in the first 36 months of life and follow-up • Evidence-based measures of adult and child obesity

• Discussion on 9 November focused on decisions that might impact 2018: obesity/weight assessment; Also recommending that HPQMC include three measures in its own “on deck” list for development and inclusion in the HPQMC menu in future years:

• Kindergarten readiness (HPQMC is already sponsoring a workgroup in this area, focusing on the health aspects of kindergarten readiness)

• Developmental screening in the first 36 months of life and follow-up • Evidence-based measures of adult and child obesity

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Health Plan Quality Metrics Committee (2/4)

Measure Name HPQMC Tentative Decision (If Measure Has Been Reviewed)

2018 CCO Incentive MeasuresAccess to Care (CAHPS) Not yet discussedAdolescent well-Care Visits Tentatively endorsedAmbulatory Care: Emergency Department Utilization

Not yet discussed

Assessments within 60 days for Children in DHS Custody

Tentatively endorsedFollow-Up: potentially adopt for a Medicaid population only

Childhood Immunization Status Tentatively endorsedCigarette Smoking Prevalence Tentatively endorsedColorectal Cancer Screening Tentatively endorsedComprehensive Diabetes Care: HbA1c Poor Control

Tentatively endorsed

Controlling High Blood Pressure Tentatively endorsedDental Sealants on Permanent Molars for Children

Not yet discussed

Developmental Screening in the First Three Years of Life

Tentatively endorsed

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Health Plan Quality Metrics Committee (3/4)

Measure Name HPQMC Tentative Decision (If Measure Has Been Reviewed)

2018 CCO Incentive Measures (cont)*Disparity Measure: Emergency Department Utilization Among Members with Mental Illness

Tentatively endorsed

Effective Contraceptive UseTentatively endorsed (adolescents WILL be included)

Patient-Centered Primary Care Home Enrollment

Not yet discussed

Prenatal & Postpartum Care: Timeliness of Prenatal Care

Not yet discussed

Screening for Clinical Depression and Follow-up Plan

Tentatively endorsedFollow-Up: replace with new HEDIS measure “Depression Screening and Follow-Up for Adolescents and Adults” when the measure has been validated

*Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

Tentatively endorsed (glide path for development of evidence based measure tabled)

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Health Plan Quality Metrics Committee

Measure Name HPQMC Tentative Decision (If Measure Has Been Reviewed)

Additional Measures Requested by M&S for 2019 MenuEHR-based Alcohol or other substance misuse screening (SBIRT)

Not yet discussed

Dental care for adults with diabetes Not yet discussedPreventive dental services utilization for adults

Not yet discussed

Coordination of care (CAHPS) Not yet discussedObesity: BMI screening and follow-up for adults

Not yet discussed

Food Insecurity Screening Not yet discussedDevelopmental Measures Proposed by M&S

Kindergarten readiness Development supportedDevelopmental screening in the first 36 months of life and follow-up

Not yet discussed

Evidence-based obesity measure Tabled

Metrics & Scoring Committee Decision: PCPCH Metric • OHA is currently working with CMS on a tribal protocol, which aims to

support CCOs in contracting with tribal clinics.

• Concern that this will negatively impact CCO performance on the metric in the short-term because many of these clinics do not yet have PCPCH recognition.

• To encourage engagement by CCOs and tribes, the Committee made a decision to remove tribal clinics from the denominator and the numerator for 2017 and 2018. Tribal clinics will be returned to the measure calculations in 2019.

• OHA will bring methodology for exclusion of tribal clinics to the TAG in January 2018. CCOs will need to self-identify members of tribal clinics that have not yet received PCPCH recognition and exclude them from the measure. • This will be done via the PCPCH survey; the survey date will be extended

to accommodate this work.

Metrics & Scoring Committee• Next meet 17 November

• Agenda• HPQMC debrief

• Update on development of health aspects of kindergarten readiness measure

• Review 2018 work plan

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Midyear Report• Format is changing:

• Will include progress by CCO on each incentive measure AND

• Deeper dive into the following measures: • Adolescent well care visits (and connection with ECU)

• ED utilization

• Disparity measure – ED use among members with mental illness

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EHR-sourced Measures

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2017 Data Proposals

• Reminder: Data Proposals are due 1/2/18

• Template has been corrected to remove columns about patient-level data test submissions

• Office hour call to address any questions• Tentatively scheduled for Wed, 12/6, 2:00-3:00

Clinical Quality Metrics Registry (CQMR) Update

• Received CMS approval of contract, so implementation can begin on technical solution

• Anticipate go-live in late 2018 • Timeline and other updates will be shared regularly

Quality Payment Program (QPP)

• CMS unofficially published 2018 final rule on 11/2

• As proposed, in 2018 Merit-based Incentive Payment System (MIPS) eligible clinicians may use

• 2014 Edition CEHRT• 2015 Edition CEHRT (and receive bonus points)• Combo of 2014 and 2015 Edition

• Summary of changes for 2018: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf

Patient-Level Data – Projected for 2018 Reporting• 2017 Guidance Document (section 5.2) contains

draft guidance for future reportingFor 2018, OHA’s draft requirements include some patient-level data submitted as QRDA Category I. OHA anticipates that to some extent, custom queries and a custom reporting template will continue to be necessary. OHA will work with the CQMR vendor and CCO stakeholders to further refine this process. OHA anticipates that in 2018, the minimum population threshold for reporting patient-level data will be 20%.

Discussion – Patient-Level Data Collection for 2018

• Thoughts on your provider network’s readiness to report in QRDA I?

• What kinds of supports are needed?

• Is a 20% threshold for patient-level data realistic for 2018?

Smoking Prevalence Measure Specs• Follow up on earlier discussions of potential change

to align to NQF0028 (tobacco use screening and cessation intervention) in future years

• No changes in measure planned at this time• After discussion in October, Metrics & Scoring decided

to stay with current smoking prevalence measure• Health Plan Quality Metrics Committee has voted to

include smoking prevalence measure for 2019

Review 2017 smoking cessation survey

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2017 Smoking Cessation Survey• Revised to simplify, both for CCOs, and OHA review

• Draft version included in packets. Please send any comments on draft survey to metrics.questions@state.or.us by 28 November.

• Timeline:• February 5, 2018: Date by which this survey **must be

completed** for credit for the 2017 measurement period.• March 5, 2018: Date by which OHA will review and send CCOs a

draft survey ‘score’ (whether passed or failed cessation benefit requirement). CCOs will then review. Any CCOs not passing the cessation benefit may send questions / additional information to OHA, which OHA will review before making final decisions.

• March 19, 2018: Last day by which CCOs may send OHA additional information on draft score.

• April 6, 2018: OHA will send final smoking cessation score to CCOs (final decision on whether passed or failed for 2017).

• TAG thoughts?

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TAG input on CCO metric guidance documents

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CCO Metrics Guidance Documents• OHA is conducting a review of the CCO incentive measure

guidance documents with the goal of improving their usefulness and ‘user friendliness’

• Currently there are guidance documents specific to the following incentive measures available on the program webpage

• Adolescent well-care visits• Assessments of children in DHS custody• Colorectal cancer screening• Dental sealants• Depression screening• Developmental screening• Effective contraceptive use• Prenatal care

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CCO Metrics Guidance Documents –questions for TAG• What do CCOs want out of these guidance documents?

• Who is the audience (CCO? Clinics? Individual Providers? All of the above? Does it depend on measure?)

• For which measures is a guidance document needed?

• What types of content are most useful?

• What formats are most user friendly?

• How often should they be updated?

• What input would the TAG like on drafts of the guidance documents?

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Draft 2018 TAG work plan (see meeting materials)

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Wrap Up

Next meeting: January 25, 2018

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