Metrics for Coordinated Care Organizations: Measuring Health Inequities. Lori Coyner, MA Director of Accountability and Quality

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1 Metrics for Coordinated Care Organizations: Measuring Health Inequities Lori Coyner, MA Director of Accountability and Quality

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3 Accountability Plan Addresses the Special Terms and Conditions that were part of the $1.9 billion agreement with the Centers for Medicare and Medicaid Services (CMS). 1. Quality Strategy 2. State Tests for Quality and Access 3. Measurement Strategy Online at 3

4 Measurement Strategy OHA has committed to measuring and reporting on multiple measure sets. Note there is significant overlap between the measure sets. 33 State Performance Measures 17 CCO Incentive Measures 16 Core Performance Measures Child Health Insurance Program (CHIP) Core Set Medicaid Adult Quality Core Set 110 US DOJ Measures 4

5 State Test for Quality and Access Annual assessment of Oregon s statewide performance on 33 metrics, across 7 quality improvement focus areas: Improving behavioral and physical health coordination Improving perinatal and maternity care Reducing preventable re-hospitalizations Ensuring appropriate care is delivered in appropriate settings Reducing preventable and unnecessarily costly utilization by super-users Addressing discrete health issues (such as asthma, diabetes, HTN) 5

6 Core Performance Metrics Included in the 1115 Demonstration Waiver Reporting only no financial incentives or penalties for OHA or CCOs More public health, population and outcome Tobacco, obesity, contraceptive use Require more developmental work 6

7 CCO Incentive Metrics 17 measures across 7 quality improvement focus areas. Measures selected by the Metrics & Scoring Committee in October 2012, revised and approved by CMS in December CCO performance tied to quality pool funding. This is a bridge strategy in moving from capitation to paying for outcomes. OHA is responsible for data collection, analysis, and reporting. 7

8 CCO Incentive Measures: Behavioral Health Measure 2011 Baseline 1 Screening for clinical depression and follow up plan 2 Alcohol and drug misuse (SBIRT) 3 Mental health and physical health assessments for children in DHS custody 4 Follow up after hospitalization for mental illness 5 Follow up care for children prescribed ADHD medication Benchmark 0% Improveme nt target (3%) only. Data Source Clinical 0.14% 13% Claims MH: 56.0% PH: 67.1% 90% Claims + ORKIDS 57.6% 68.0% Claims Initiation: 52.3% C&M: 61.0% Initiation: 52.3% C&M: 63.0% Claims

9 CCO Incentive Measures: Maternal & Child Health Measure 2011 Baseline 6 Prenatal care initiated in the first trimester 7 Reducing elective delivery before 39 weeks 8 Developmental screening by 36 months 9 Adolescent well care visits Benchmar k Data Source 65.3% 69.4% Claims TBD 5% or below Hospital 20.9% 50.0% Claims 27.1% 53.2% Claims

10 CCO Incentive Measures: Chronic Conditions Measure 2011 Baseline 10 Uncontrolled diabetes (HbA1c >9) 11 Controlling hypertension (<140/90) 12 Colorectal cancer screening Benchmark Data Source TBD 34% Clinical TBD 60% Clinical 32.5% Improvement target (3%) only Claims

11 CCO Incentive Measures: Appropriate Access Measure 2011 Baseline Benchmark Data Source 13 Ambulatory care: emergency department and outpatient utilization 14 Rate of patientcentered primary care home (PCPCH) enrollment 15 Access to care: getting care quickly (CAHPS survey, adult and child) ED: 61.0/1,000 member months OP: 364.2/1,000 member months ED: 44.4/1,000 member months OP: 439.0/1,000 member months Claims 51.7% 100% CCO report 83.0% 87.0% CAHPS survey

12 CCO Incentive Measures Measure 2011 Baseline Benchmark Data Source 16 Patient experience of care: health plan information and customer service (CAHPS survey, adult and child) 17 Electronic health record (EHR) adoption 78.0% 84.0% CAHPS survey 19% 49.2% OHIT / CMS + CCO Provider Capacity Report

13 The Big Picture 13

14 OHP 2011 Statewide Snapshot: Race Statewide Dec 2011 Snapshot Children Adults Total % Count % Count % Count African American Am. Indian/ Alaskan Native Asian White Pacific Islander Other Unknown Total 4.1% 1.9% 2.5% 61.1% 0.6% 0.1% 29.8% 100.0% 14,727 6,632 8, ,694 1, , , % 2.0% 3.8% 78.9% 0.3% 0.0% 10.6% 100.0% 10,491 4,954 9, , , , % 1.9% 3.0% 68.3% 0.4% 0.0% 22.0% 100.0% 25,218 11,586 18, ,018 2, , ,617

15 OHP 2011 Statewide Snapshot: Ethnicity Ethnicity - Statewide Dec 2011 Snapshot Hispanic Non - Hispanic Other Unknown Total Children Adults Total % Count % Count % Count 28.1% 62.8% 0.0% 9.1% 100.0% 99, , , , % 87.0% 0.0% 5.6% 100.0% 17, , , , % 72.6% 0.0% 7.7% 100.0% 117, , , ,617

16 How will we provide meaningful data to CCOs for assessing and improving health equity? 16

17 First step CCO level data on race, ethnicity and primary language 2011 baseline metrics by race, ethnicity and language Next by race, ethnicity and language 2013 data Disease and health status Metrics: services and medical intervention Change over time Additional subgroups 17

18 Challenges Difficult to stratify all CCO metrics by race, ethnicity, and language Small numbers for some CCOs CCO metrics demonstrate aspects of health but not all Additional subgrouping require definitions and data may not be available. 18

19 Health System Transformation Quarterly Report Published May August 2013 Starting point for measuring access and quality of care Transparent reporting Includes financial, utilization, access and quality metrics. Next scheduled for November 2013 Preliminary 2013 data: Jan June Statewide baseline 2011 incentive metrics stratified by race and ethnicity (17 of 33) First step in reporting of metrics by race and ethnicity 19

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21 Future Reporting Race, ethnicity, and language o Statewide and CCO level 2013 metrics Disability o Work group convening to define Severe and persistent mental illness Rural vs urban Vulnerable populations (e.g., dual eligibles) Specific diagnoses (e.g., chronic conditions, addictions) 21

22 Contact Us Metrics Questions: Lori Coyner, MA Director Accountability and Quality Sarah Bartelmann Metrics Coordinator 22