OHA’s Quality and Accountability Metrics

1. OHA’s Quality and Accountability Metrics Sarah Bartelmann, MPH Office of Health Analytics

2. Health System Transformation: Achieving the Triple Aim 2

3. Transforming the Health Care System 3

4. 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). Quality Strategy State “Tests” for Quality and Access Measurement Strategy Online at www.oregon.gov/oha/OHPB/Pages/health-reform/cms-waiver.aspx 4

5. Oregon’s Medicaid Program Commitments to CMS • Reduce the annual increase in the cost of care (the cost curve) by 2 percentage points. • Ensure that quality of care improves. • Ensure that population health improves. • Establish a 1 percent withhold for timely and accurate reporting of data. • Establish a quality pool. 5

6. Measurement Strategy 6

7. State Performance Measures • Annual assessment of Oregon’s performance on 33 measures. • Ensure that quality of care and access to care does not degrade during health system transformation. • Financial penalties to the state if we fail to show improvement. State “test” of quality and access. 7

8. CCO Incentive Metrics • Annual CCO performance on 17 measures tied to incentive funding (“quality pool”). • Measures selected by the Metrics & Scoring Committee. • Measures are the same for 2013 and 2014; will be revised for 2015. • Measure Specifications + Methodology online at www.oregon.gov/oha/Pages/CCO-Baseline-Data.aspx 8

9. Metrics & Scoring Committee • 2012 Senate Bill 1580 establishes committee • Nine members serve two-year terms. Must include: • 3 members at large; • 3 members with expertise in health outcome measures; • 3 representatives of CCOs • Committee uses public process to identify objective outcome and quality measures and set benchmarks. • Online at http://www.oregon.gov/oha/Pages/metrix.aspx 9

10. Quality Pool • Incentive funds reward CCOs for improving quality, access, and health outcomes. • Quality pool = 2% of actual CCO paid amounts in 2013. Likely to increase in future years. • CCOs must meet either the benchmark or an improvement target for each of the 17 measures to earn quality pool funds. Quality Pool methodology online at: www.oregon.gov/oha/Pages/CCO-Baseline-Data.aspx 10

11. Health System Transformation Quarterly Progress Reports 11 www.oregon.gov/oha/metrics/

12. What progress data indicate • Developmental Screening is up. First nine months indicate that developmental screenings are up by 52% since 2011. 12

13. Developmental Screening is up. Some CCOs show large improvements and 3 are at or over the benchmark for 2013

14. What progress data indicate • Enrollment in Patient-Centered Primary Care Homes (PCPCH) has increased markedly. Over 75% of members are enrolled in a PCPCH. Percentage of patients who were enrolled in a recognized patient-centered primary care home 14

15. What progress data indicate • CCO primary care visits are up nearly 16% from 2011 baseline. Ambulatory Care: Primary care medical visits (includes immunizations/injections) Rate primary care visits per 1,000 members 15

16. What progress data indicate • Emergency department (ED) utilization is down. First nine months indicate that ED utilization is down 13% from 2011. Ambulatory Care: ED utilization Rate of patient visits to the ED per 1,000 member months Lower is better Benchmark: 2012 national Medicaid 90th percentile. 16

17. What progress data indicate • Adoption of electronic health records (EHR) has dramatically increased since 2011. Percentage of eligible individual providers within a CCO’s network and service area who qualify for an EHR incentive payment from Medicaid or Medicare. 17

18. What’s Next? 18

19. 2013 Results! • OHA will release final 2013 data and quality pool earnings on June 24, 2014. • Results will be presented to the Oregon Health Policy Board on July 1,2014. • Report will be posted online at www.oregon.gov/oha/Metrics/Pages/index.aspx 19

20. New Metrics & Scoring Committee Members • OHA will appoint up to 3 new members to the Metrics & Scoring Committee in June. • New members will serve 2-year terms (August 2014 – August 2016) • Existing members continuing with the Committee will be re-appointed for a 1-year term (through August 2015). 20

21. 2015 Measure Selection • OHA fielded survey (May– June 2014) to collect stakeholder input for the Metrics & Scoring Committee’s consideration. • OHA will present results and proposed measures to the Committee in July. 21

22. Hot Topics for 2015 • Population Health measures (e.g., tobacco use) • Dental measures (e.g., sealants, annual visits) • ACES screening • Kindergarten readiness 22

23. Future Metrics Work • Sub-population analysis: • Race, ethnicity, language and disability • Severe and persistent mental illness • Specific diagnoses (e.g., chronic conditions, addictions) • Operationalizing new measures: dental, population health, long-term care, and early learning measures. • Cross-payer analysis of incentive measures (PEBB, OEBB, Commercial) 23

24. Questions? Sarah BartelmannMetrics Coordinator(cell) 503.490.5689sarah.e.bartelmann@state.or.us 24