May 2017

Health Plan Quality Metrics Committee May 11, 2017 1:30-4:00 pm

Location: State Library, 250 Winter St NE, Conference Rm 103; Salem, OR 97301

Conference Line: Dial 1-877-336-1828; Committee code: 8158922; Public, listen-only code: 9657836 Webinar: https://attendee.gotowebinar.com/rt/1703536419076343809

# Time Item Presenter Action Item

1 1:30 pm – 1:35 pm

Welcome & Meeting Overview Margaret Smith-Isa

(OHA)

2 1:35 pm – 1:50 pm

Review and approve April meeting minutes Review and approve Committee Bylaws Select Committee Chair and Vice-Chair Review Committee scope established in SB 440

Margaret Smith-Isa

3 1:50 pm-2:00 pm

Public Comment

4 2:00 pm – 2:20 pm

Review Committee Work Plan

Review, discuss and obtain Committee input on high level work plan

Margaret Smith-Isa, Jon Collins (OHA)

5 2:20 pm – 2:50 pm

Overview of current quality measurement in state health care programs

Medicaid CCOs Jon Collins

6 2:50 pm – 3:00 pm

BREAK

7 3:00 pm – 3:50 pm

Overview of current quality measurement in state health care programs

Public Employees’ Benefit Board (PEBB)

Oregon Educators Benefit Board (OEBB)

Department of Consumer and Business Services (DCBS) Oregon Health Insurance Marketplace

Margaret Smith-Isa, Shaun Parkman, Tom

Syltebo, Chiqiui Flowers, Katie Button

(DCBS)

8 3:50 pm Wrap up / adjourn Margaret Smith-Isa

Next Meeting – June 8th, 1:30-4:00 pm

Clackamas Community College Wilsonville Training Center

29353 SW Town Center Loop E. Wilsonville, OR, Room #155

Health Plan Quality Metrics Committee

Bylaws (5/11/2017 Draft)

ARTICLE 1 Committee and its Members

• The Health Plan Quality Metrics Committee (“Committee”) is established by Oregon’s 2015 Senate Bill 440, Section 2. The Committee’s purpose is to be the single body to align health outcome and quality measures used in Oregon and is charged with identifying a menu of health outcome and quality measures to be used by coordinated care organizations, or health benefit plans sold through the insurance exchange or offered by the Oregon Educators Benefit Board or the Public Employees Benefit Board.

• Members of the Committee will be appointed by, and serve at the pleasure of the Governor. Committee members will be appointed by the Governor for an initial 1-year term. Committee members may be re-appointed at the discretion of the Governor.

• Members of the Committee who no longer represent the organization or role they were selected for can continue to serve on the Committee at the discretion of the Governor.

• Members of the Committee are not entitled to compensation for services but shall be reimbursed for actual and necessary travel expenses incurred by them by their attendance at committee meetings, in the manner and amount provided in ORS 292.495.

ARTICLE II Committee Officers and Duties

• The Committee shall select a Chair from among its members. The Chair will serve for 12-months from the date of their election.

• Duties of the Chair are: o Preside at all meetings of the Committee. o Coordinate meeting agendas after consultation with Committee staff. o Review all draft Committee meeting minutes prior to the meeting at which they are to

be approved. o Be advised of all presentations or appearances before legislative committees that relate

to the work of the Committee. o The Chair may designate other Committee Members to perform duties related to

Committee business such as, but not limited to, attending other agency or public

Health Plan Quality Metrics Committee Bylaws (4/13/2017 Draft)

meetings, meetings of the Board, training programs, and approval and review of documents that require action of the Chair.

• The Committee shall select a Vice-Chair from among its members. The Vice-Chair will serve for 12

months from the date of their election.

• Duties of the Vice Chair are: o Perform all of the Chair’s duties in his/her absence or inability to perform; o Consult with Chair and staff on issues related to Committee business as needed o Perform any other duties assigned by the chair.

ARTICLE III Committee Meetings • The Committee shall meet at least quarterly and more frequently at the call of the Chair in

consultation with the Committee Members and staff.

• The Committee shall conduct all business meetings in public and in conformity with Oregon Public Meetings Laws.

• The preliminary agenda will be available from the Committee staff and posted on the Committee website http://www.oregon.gov/oha/analytics/Pages/Quality-Metrics-Committee.aspx at least two working days prior to the meeting.

• A majority of Committee Members shall constitute a quorum for the transaction of business.

• If a Committee Member is unable to attend a meeting in person, the Member may participate by conference telephone or internet conferencing provided that the Member can be identified when speaking, all participants can hear each other and members of the public attending the meeting can hear any Member of the Committee who speaks during the meeting. A Committee Member participating by such means shall be considered in constituting a quorum.

• The Committee will conduct its business through discussion, consensus building and informal meeting procedures. The Chair may establish procedural processes to assure the orderly, timely and fair conduct of business.

• Decisions will be made by vote. The Chair will determine whether a voice vote or roll call vote will be

used for specific decisions, taking into consideration requests of Committee Members. Use of a vote and its results will be recorded in the meeting minutes. Committee members attending via conference telephone or internet conferencing are considered present and may vote. Votes via electronic mail are not permitted. Proxy votes are not permitted.

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Health Plan Quality Metrics Committee Bylaws (4/13/2017 Draft)

• Official action by the Committee requires the approval of a majority of Members in attendance.

• Committee Members shall inform the Chair, Vice-Chair, or Committee staff with as much notice as

possible if unable to attend a scheduled Committee meeting. Committee staff preparing the minutes shall record the attendance of Committee Members at the meeting for the minutes.

• The bylaws in this section apply to the full Committee and any subcommittees or designated

workgroups. ARTICLE IV Stakeholder Engagement • The Committee will seek input from stakeholders using the following process:

o The timing of Committee engagement of various stakeholders will coincide with specific

quality measurement topics as these are scheduled on the Committee’s work plan.

o Stakeholder input will be accepted in the form of oral presentations before the Committee and/or briefs, white papers, studies or other written documents. Oral input provided by stakeholders should be accompanied by written documentation of oral presentations or comments offered.

o The Committee may elect to include stakeholder(s) in specific focus areas assigned to

subcommittees as identified as necessary

o A public comment opportunity will be provided at every Committee meeting. Individuals or organizations interested in providing public comment to the Committee should refer to the Committee’s Guidelines for Public Comment.

o The Committee will provide methods for stakeholders to submit electronic input via

channels that may include email and/or an online input form on the Committee website. ARTICLE V Amendments to the Bylaws and Rules of Construction

• These Bylaws may be amended upon the affirmative vote of a majority of Members of the

Committee.

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Health Plan Quality Metrics Committee

Guidelines for Public Comment

The Health Plan Quality Metrics (HPQM) Committee wants to hear from stakeholders to do its work effectively. Please follow these guidelines to provide public comment to the Committee.

If providing oral public comment before the Committee:

• Attend a scheduled Committee meeting. The Committee meeting schedule is posted at http://www.oregon.gov/oha/analytics/Pages/Quality-Metrics-Committee.aspx

• Sign in on the Public Comment sing-in sheet • The Committee Chair will call you to the table during the public comment period • Introduce yourself for the record, including name and title/affiliation • Provide your comments. Please limit comments to a maximum of five minutes • If you have written documentation to accompany your oral comments, please bring 18

copies and provide the documentation to Committee staff who will distribute it to Committee members

If providing oral comment via telephone during a Committee meeting:

• Public comment via telephone will be invited during the established public comment period on the Committee’s meeting agenda. It is helpful to notify Committee staff ahead of time if you plan to dial into the meeting and provide telephonic public comment, however this advance notice is not required.

• Introduce yourself for the record, including name and title/affiliation • Provide your comments. Please limit comments to a maximum of five minutes and

speak slowly and clearly to ensure your comments can be heard by all Committee members.

• You may submit written documentation to accompany your comments by mailing these to: Health Plan Quality Metrics Committee, Attn: Margaret Smith-Isa, 500 Summer St NE E-89, Salem, OR 97301 or emailing them to Metrics.Questions@state.or.us and indicating “HPQM Committee Public Comment” in the Subject line

If providing written public comment:

• Please provide a one-page Executive Summary of your comments • Attach and additional supporting documentation to the one-page summary • Submit written public comment to the Committee via one of the following options:

Health Plan Quality Metrics Committee – Guidelines for Public Comment

o Mail to: Health Plan Quality Metrics Committee, Attn: Margaret Smith-Isa, 500 Summer St NE E-89, Salem, OR 97301

o E-mail to Metrics.Questions@state.or.us and indicate “HPQM Committee Public Comment” in the Subject line of your email

The Committee will retain and consider all public comment received, but may not directly address public comment during the meeting in which it is provided. Public comment will be directly addressed and/or discussed during Committee meetings at the discretion of the Committee Chair and will depend on the extent to which specific comments provided relate to the Committee’s established meeting agenda topics.

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Health Plan Quality Metrics Committee May 11, 2017

Candidates for Committee Leadership

Committee Chair

• Kristen Dillon: I currently serve as the Director of the Columbia Gorge CCO, employed by PacificSource Community Solutions since 2015. Prior to that, I was an owner of an independent primary care practice in Hood River where I worked as a family physician for 15 years. I continue to work in a limited capacity at the frontier clinic in Sherman County. During my years of clinical care, I have worked with patients and clinic staff through the beginning and now the middle of quality measurement in health care. I see the potential to improve care and health outcomes and the potholes along the way that increase frustration, distraction, and cost for clinicians and organizations. During those years I also became deeply committed to Oregon’s health care transformation process as a way to improve the experience of people who access health care, to improve the outcomes of our health care system, and to free up precious state resources for other uses. My work for this goal included serving a term on our state’s Medicaid Advisory Committee, helping to establish and then serving on the Columbia Gorge Health Council (our CCO’s governing board), and contributing to leadership of the Central Oregon Independent Practice Association through Board and committee membership. My other related experience includes experience and basic training in health research, including serving as coinvestigator on a Patient Centered Outcomes Research Institute Pipeline-to-Proposal grant for the last three years, on the advisory committee of a large community based clinical trial (CASCADE), and on the steering committee of the Oregon Rural Practice Research Network. I also serve as a Board Chair for One Community Health, our region’s federally-qualified health center, and a Director of the Oregon Association of Family Physicians.

Committee Vice-Chair

• Currently no candidates

Health Plan Quality Metrics Committee May 11, 2017

From Senate Bill 440

• The committee shall work collaboratively with the Oregon Educators Benefit Board, the Public Employees’ Benefit Board, the Oregon Health Authority and the Department of Consumer and Business Services to adopt health outcome and quality measures that are focused on specific goals and provide value to the state, employers, insurers, health care providers, and consumers.

• The committee shall be the single body to align health outcome and quality measures used in the state with the requirements of health care data reporting to ensure that the measures and requirements are coordinated, evidence-based and focused on long-term statewide vision.

• The Oregon Health Authority, the Department of Consumer and Business Services, the Oregon Educators Benefit Board, and the Public Employees’ Benefit Board are not required to adopt all of the health outcome and quality measures identified by the committee but may not adopt any health outcome and quality measures that are different from the measures identified by the committee.

• The measures must take into account the recommendations of the metrics and scoring subcommittee created in ORS 414.638 and the differences in the populations served by coordinated care organizations and commercial insurers.

• This subsection does not prevent the Oregon Health Authority, the Department of Consumer and Business Services, commercial insurers, the Public Employees’ Benefit Board or the Oregon Educators Benefit Board from establishing programs that provide financial incentives to providers for meeting specific health outcome and quality measures adopted by the committee.

Health Plan Quality Metrics Committee

Draft Work Plan (5/11/2017)

Meeting Activities Meeting #1 April 13, 2017

Charter – Committee purpose, measure alignment goals, deliverable Bylaws-committee consensus process, stakeholder input process, role of chair/vice-chair Quality measure background and alignment

• Handout on quality measure background –further offline background discussion available to interested committee members

• National Context o Overview of national measure sets o Measure alignment efforts to date o Alignment challenges and opportunities

Meeting #2 May 11, 2017

Finalize bylaws Select Chair/Vice-Chair Review Work plan Overview of current measurement strategy in state health care programs

• Medicaid CCOs • PEBB • OEBB • Oregon Health Insurance Marketplace

Meeting #3 June 8, 2017

Establish measure criteria • Determine whose performance to measure • Identify intended use(s) of the measure set (purpose) • Identify measure selection criteria (guiding principles) • Define the selection decision process • Identify populations and domains for measurement • Identify potential data sources and operational means • Estimate desired measure set size

Meeting #4 July 13, 2017

Review crosswalk of state measure sets with other key measure sets, including (not exhaustive)

• CMS measure sets (Core Quality, MIPS, STAR, CPC+) • Oral health • Behavioral health • Public health

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Health Plan Quality Metrics Committee – Work Plan (5/11/2017)

• Commercial value-based contracting measures • Oregon Health Care Quality Corporation measures

Determine measure sets from which initial candidate measures shall be drawn Identify domains for which there may not be sufficient numbers of measures among the aligning measure sets

Meeting #5-9 August 10, 2017 September 14, 2017 October 12, 2017 November 9, 2017 December 14, 2017

Measure review and tentative selection (based on established criteria) Active stakeholder engagement – input and recommendations from stakeholders reviewed on a schedule that coincides with specific measurement topics or domains as these occur on Committee meeting agendas. Stakeholders include but are not limited to:

• Metrics & Scoring Committee • Primary Care Payment Reform Collaborative • Early Learning Council/Early Learning Division • Health system and provider organizations • Independent/nonprofit quality improvement organizations • Health equity organizations • Consumer organizations

Subcommittees/Work Groups

• Assess need for and identify potential subcommittees and/or workgroups

• Define tasks and processes for any subcommittees or workgroups established

• Review and consider recommendations from any subcommittees or workgroups per defined processes

Meeting #10-12 January 11, 2018 February 8, 2018 March 8, 2018

Finalize initial measures set Define 2018 work plan and timelines and processes for ongoing refinement and maintenance of measure set

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Coordinated Care Organizations (CCO) Metrics

Health Plan Quality Metrics Committee

11 May 2017

Jon C. Collins, PhD

Office of Health Analytics Director

HEALTH POLICY & ANALYTICS

Office of Health Analytics

HEALTH POLICY & ANALYTICS

Office of Health Analytics

2

3

Oregon’s 1115 Waiver 2017-2022Our Goals• Build on transformation with focus on integration of physical, behavioral,

and oral health care through a performance driven system.

• More deeply address social determinants of health and health equality

with the goal of improving population health and outcomes.

• Commit to ongoing sustainable rate of growth, advance the use of value-

based payments, and promote increased investments in health related

services.

• Continue to expand the coordinated care model.

Carrot & Stick • Establish a 1% withhold for timely & accurate data.

• Establish a quality pool (pay for performance).

4

Oregon Health Authority Quality & AccountabilityCore Performance Measures• Included in Oregon's 1115 demonstration waiver - some focus on

population health

• There are no financial incentives or penalties associated with

them

State Performance Measures• Annual assessment of statewide performance on 33 measures.

• In previous waiver, included financial penalties to the state if

quality goals are not achieved.

CCO Incentive Measures• Annual assessment of CCO performance measures (number

varies each year).

• Quality pool paid to CCOs for performance.

• Compare current year to baseline (performance in previous year)

CCO Incentive Measure Quality Pool

• Incentive funds reward CCOs for improving quality, access, and

health outcomes.

• Quality pool = % of actual CCO paid amounts.

• 2.00% in 2013

• 3.00% in 2014

• 4.00% in 2015

• 4.25% in 2016

• TBD in 2017

• CCOs must meet either the benchmark or an improvement target for

each of the measures to earn quality pool funds.

Quality Pool methodology online at:

http://www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx

6

2016 Quality Pool Distribution (payment in June 2017)

To earn their full quality pool payment, CCOs must:

Meet the benchmark or improvement target, or the

measurement and reporting requirements for the clinical

measures, on at least 75% of the incentive measures; and

Have at least 60 percent of their members enrolled in a

patient-centered primary care home (PCPCH).

Money left over from the quality pool goes to the challenge pool. To earn challenge pool payments, CCOs have to:

Meet the benchmark or improvement target on the four

challenge pool measures: (1) depression screening; (2)

diabetes HbA1c control; (3) developmental screening; and (4)

drug and alcohol screening (SBIRT).

Selecting the CCO Incentive Measures: Metrics and Scoring Committee• 2012 Senate Bill 1580 established 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 CCO incentive

measures and benchmarks.

• Per SB 440 of 2015, is a subcommittee of Health Plan

Quality Metrics Committee.

• Online at www.oregon.gov/oha/analytics/Pages/Metrics-

Scoring-Committee.aspx

CCO Measure Selection: A Public Process

Metrics & Scoring Committee

Metrics Technical Advisory Workgroup

Public Testimony: advocates, organizations, CCOs, providers

Stakeholder Input:

Providers, CAPs, CACs, community

Health Plan Quality Metrics Committee

Metrics & Scoring Committee Charge: Measures should…• Address multiple domains

• Health outcomes, patient experience, quality, and access

• Represent services CCOs provide

• Ambulatory care, inpatient care, chemical dependency and mental

health treatment, oral health care, care coordination, prevention, etc…

• Represent populations CCOs serve

• Adults, children, demographics such as race, ethnicity, disability, SPMI

• Align with Quality Improvement Focus Areas

• From Oregon’s 1115 demonstration waiver

• Be national / standardized measures

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Other Selection Criteria• Transformative potential

• Consumer engagement

• Relevance

• Consistency with national and state measures

(with room for innovation)

• Attainability

• Accuracy

• Feasibility of measurement (data source, timing)

• Reasonable accountability

• Range / diversity of measures

• Right number of measures

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General Measure Selection Process

Collect them all! Compile library of measures

Review each measure in library: determine in / out / maybe

Multiple passes through included and “maybe” lists – apply criteria

Review existing performance data and identify benchmarks

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2017 CCO incentive measures1. Access to care (CAHPS survey)

2. Adolescent well-care visits

3. Ambulatory care: emergency department utilization

4. Childhood immunization status

5. Colorectal cancer screening

6. Controlling high blood pressure

7. Dental sealants on permanent molars for children

8. Depression screening and follow-up plan

9. Developmental screening in the first 36 months of life

10.Diabetes HbA1c poor control

11.Effective contraceptive use among women at risk of unintended pregnancy

12.Electronic health record (EHR) adoption

13.Follow-up after hospitalization for mental illness

14.Mental and physical health assessments for children in DHS custody

15.Patient-centered primary care home (PCPCH) enrollment

16.Prenatal and postpartum care: timeliness of prenatal care

17.Satisfaction with care (CAHPS)

2018 Areas of Interest

• Alternate patient experience measures

• Kindergarten readiness

• Obesity

• Dental measures

• Medication therapy / pharmacy measures

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For More InformationMetrics & scoring committee webpage:

www.oregon.gov/oha/analytics/Pages/Metrics-Scoring-Committee.aspx

CCO metrics Technical Advisory Group (TAG) webpage:

www.oregon.gov/oha/analytics/Pages/Metrics-Technical-Advisory-

Group.aspx

Measure specifications and guidance documents:

www.oregon.gov/oha/analytics/Pages/CCO-Baseline-Data.aspx

Metrics reporting:

www.oregon.gov/oha/Metrics/Pages/HST-Reports.aspx

Jon C. Collins, PhDDirector of Health Analytics

503.569.0044jon.c.collins@state.or.us

Questions?

Sara Kleinschmit, MScMetrics Coordinator

971.673.3364sara.kleinschmit@state.or.us

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Health Plan Quality Metrics Committee – May 2017

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Coordinated Care Organizations (CCOs) for Medicaid P

urp

ose

& A

pp

roac

h

Start date for current quality measures

2013

Performance measurement period (i.e., calendar year, etc.)

Calendar year

Number of measures in the measures set

17 (varies each year)

Who/what do current quality measures apply to?

Medicaid members enrolled in CCOs

How are current quality measures used (or intended to be used)?

The CCO incentive metrics form a fully-at-risk quality pool. The quality pool is a bridge strategy to move CCO payments from utilization to value. Over time, the proportion of a CCO’s global budget based on capitation is expected to decrease as the proportion based on incentives tied to improvements in outcomes and efficiency increases. The quality pool itself is a percentage of actual CCO paid amounts, as below:

2.00% in 2013

3.00% in 2014

4.00% in 2015

4.25% in 2016

TBD in 2017

The quality pool is divided among all CCOs based upon their size (number of members) and performance on the incentive measures. CCOs must meet either the benchmark or improvement target in order to earn quality pool funds. If a CCO does not earn its dollars for a particular measure, those funds are added to a ‘challenge pool’. CCOs can earn these challenge pool dollars by meeting the benchmark or improvement target on a subset of the larger measure set, identified as the ‘challenge pool’ measures1.

1 Note that though the challenge pool is currently comprised of a subset of the larger CCO incentive measure set, the Metrics & Scoring Committee could choose to identify outside metrics for the challenge pool (i.e., it is not limited to the broader incentive measure set).

Health Plan Quality Metrics Committee – May 2017

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Statutory, regulatory or federal waiver language pertaining to the specific measures in the measure set (if any)

Oregon’s 1115 Medicaid Demonstration (often referred to as “the waiver”) includes the following language regarding the CCO incentive measure program. NB: these are direct quotations from the waiver; page numbers are in parentheses. The full waiver text can be found here: http://www.oregon.gov/oha/hpa/Medicaid-1115 Waiver/Documents/Waiver%202017.pdf.

The state’s strategy for a robust measurement includes the Metrics and Scoring Committee. The Committee reviews data and the relevant literature, determine which measures will be included in the CCO incentive program, and establishes the performance benchmarks and targets to be used in this incentive program. The Committee will endorse specifications for each measure. In future years, the Committee will review earlier decisions and make adjustments as needed. The Metrics and Scoring Committee recommends metrics that will be used to determine financial incentives for CCOs. (p. 38)

The Metrics and Scoring Committee has selected an initial set of 17 measures, listed below. OHA will be collecting baseline data for these measures and conducting some statistical testing to determine if the selected measures and performance targets are feasible. Any revisions to the measure set will be made in coordination with the Metrics and Scoring Committee. (page 224)

Incentive Measures. The Metrics and Scoring Committee will likely consider additional measures,

either as part of the Oregon Health Authority’s overall measurement framework or as incentive metrics in future years. The Committee will be reviewing CCO performance data, improvement over baseline, and distribution of the quality pool to determine if the initial incentive metrics selected were the right combination of measures to improve quality and access for the Oregon Health Plan population. Incentive measures may be added in subsequent years and it is likely that other measures will be retired from the list, either due to measurement concerns or progress. CCO performance may improve significantly enough on select measures that the Committee refocuses efforts to different areas needing improvement. (page 280)

Stra

tegy

Key criteria (in brief) used to select current quality measures

The Metrics & Scoring Committee, which identifies the CCO incentive measures, has adopted a formal measure selection criteria, including transformative potential, relevance, and measurement and feasibility of measurement. For details, see http://www.oregon.gov/oha/analytics/metricsdocs/Measure_selection_criteria.pdf.

Health Plan Quality Metrics Committee – May 2017

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Process used to select quality measures

Current Process

The Metrics & Scoring Committee was established in 2012 by Senate Bill 1580 for the purpose of recommending incentive measures for CCOs2. The Metrics & Scoring Committee is also tasked with identifying the benchmarks for the CCO incentive measures.

The Metrics & Scoring Committee also established a CCO metrics technical advisory workgroup (TAG). OHA staffs this workgroup, which meets monthly. The TAG meetings are public meetings, where all CCOs are invited to send representatives to participate in the discussion. TAG meetings focus on operationalizing selected measures, developing measure specifications, and making recommendations to the Metrics and Scoring Committee and OHA.

The Metrics & Scoring Committee established the initial CCO incentive measure set via a public process, and with the support of Bailit Heath. The initial set was agreed with CMS as part of Oregon’s 1115 Medicaid waiver, though as above the waiver language allows the Metrics & Scoring Committee to review and update the measure set.

The Committee meets at least quarterly, and updates the measure set on an annual basis. In updating the measure set, the above criteria are consulted, and the Committee takes feedback from members of the public, the TAG, OHA, subject matter experts, and other interested stakeholders. Minutes from past Committee meetings are available here: http://www.oregon.gov/oha/analytics/Pages/Metrics-Scoring-Committee.aspx

Future, as HPQMC Established

In 2015, Senate Bill 440 created the Health Plan Quality Metrics Committee (HPQMC), and made the Metrics and Scoring Committee a subcommittee of the HPQMC. Senate Bill 440 stipulates that on an annual basis the Metrics & Scoring Committee will select CCO incentive measures from the list established by the HPQMC. The Metrics & Scoring Committee is also to review its measure set annually, and make recommendations to the HPQMC each year. In determining the measures in the HPQMC list, Senate Bill 440 notes the HPQMC “must take into account the recommendations

2 The state must also report two other types of non-incentivized measure sets to CMS. These measure sets are outside the prevue of the Metrics & Scoring Committee; the Metrics & Scoring Committee only has authority to identify CCO incentive measures. For information, they are:

State performance measures. OHA reports these measures to CMS and is held accountable for statewide performance on these metrics. Some of these measures are also incentive measures.

Core measures. OHA reports these measures to CMS, but there are no financial incentives or penalties associated with them. These are generally more population health focused. Some of these measures are also incentive measures.

Health Plan Quality Metrics Committee – May 2017

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of the metrics and scoring subcommittee created in ORS 414.638 and the differences in population served by coordinated care organizations and commercial insurers.”

Method used to revise/update current quality measures

As above the Metrics & Scoring Committee reviews the measures included in the measure set on an annual basis, with consultation by a plethora of stakeholder groups. In addition to reviewing the selection criteria, the Committee has also established criteria for use in retiring current metrics (see http://www.oregon.gov/oha/analytics/metricsdocs/MS_Committee_Measure_Retirement_Checklist.pdf).

Frequency with which current quality measures are updated/revised

Annually

Attachment: Current health outcome and quality measures list (see

http://www.oregon.gov/oha/analytics/CCOData/2017%20CCO%20Incentive%20Measure%20Benchmarks.pdf)

HEALTH POLICY & ANALYTICS

Office of Health Analytics

Public Employees’ Benefit Board (PEBB) and Oregon Educators Benefit Board (OEBB)

Health Plan Quality Metrics Committee

11 May 2017

Margaret Smith-Isa

PEBB Program Development

PEBB & OEBB Goals and Purpose

• PEBB and OEBB plans cover 6% of Oregon’s population

– 270,000 members - employees and dependents

• Members live and work in every Oregon county

Goals

• Improve member health with fully-covered preventive services and wellness programs

• Enhance quality care through the Coordinated Care Model (CCM)

• Contain costs by maintaining a sustainable budget rate of growth

• Advance health care transformation

2

PEBB and OEBB: Strategic Plan

• Advance health care transformation with plans that

– Coordinate care and improve access to services

– Hold growth at 3.4%

– Integrate coordinated, patient-centered care – physical, mental and

dental

– Demonstrate better health outcomes

– Embrace alternative payment models

– Support new partnerships and strengthen existing ones

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4

Whom PEBB Serves

36,844

14,671

691

61,842

19,521

1,177

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

State Agencies Universities Lottery & Semi Independent

2016 PEBB Active Enrollments

Employees Dependents

PEBB Enrollment

• PEBB currently contracts with four insurance carriers to provide employee health benefits

• Members moving from preferred provider organization (PPO) plan

• Members choosing coordinated care model (CCM) plans with lower premium share

5

Whom OEBB Serves

• School Districts (188)

• Educational Service Districts (19)

• Charter Schools (20)

• Community Colleges (16)

• Local Government (2)

• Special districts (3)

6

OEBB Member Enrollments

7

Employees, 47,266

Employees, 9,617Employees, 994

Dependents, 70,458

Dependents, 11,661Dependents, 1,026

0

20,000

40,000

60,000

80,000

100,000

120,000

School Districts ESDs/Community Colleges/CharterSchools

Local Governments/SpecialDistricts

2016 OEBB Active Enrollments

Employees Dependents

OEBB Enrollment• OEBB currently contracts with two insurance carriers to provide health benefits

• Members moving from preferred provider organization (PPO) plan

• Members choosing coordinated care model (CCM) plans with lower premium share

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For More Information

Public Employees’ Benefit Board:

http://www.oregon.gov/OHA/PEBB/Pages/index.aspx

Oregon Educators Benefit Board:

http://www.oregon.gov/oha/OEBB/Pages/index.aspx

Margaret Smith-IsaPEBB Program Development Coordinator503.378.3958margaret.g.smith-isa@state.or.us

Questions?

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Health Plan Quality Metrics Committee – May 2017

Public Employees’ Benefit Board (PEBB) Pu

rpos

e &

App

roac

h Start date for current quality measures PEBB’s current quality measures were incorporated into health plan contracts effective

1/1/2017 Performance measurement period (i.e., calendar year, etc.)

Measurement is conducted on a calendar year basis, which coincides with PEBB’s plan year

Number of measures in the measures set PEBB currently includes 15 quality and outcome measures in health plan contracts

Who/what do current quality measures apply to?

The quality and outcome measures apply to four health insurance plans that PEBB contracts with to provide benefits to approximately 50,000 state and university system employees and roughly 80,000 spouses/dependents.

How are current quality measures used (or intended to be used)?

The measures are used to track health plan performance with regard to advancing quality, with the intent of assessing year over year performance for a given health plan. Financial incentives/penalties are tied to plans meeting established performance targets on measures.

Statutory, regulatory or federal waiver language pertaining to the specific measures in the measure set (if any)

No specific statutory or regulatory language pertains to PEBB’s current quality measures.

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Key criteria (in brief) used to select current quality measures

PEBB’s quality measures were selected to align with incentive measures adopted by the Oregon Health Authority for Medicaid CCOs, leveraging technical work already completed by the Metrics & Scoring Committee. PEBB retains discretion to refrain from including measures that do not broadly apply to PEBB health plans, and to prioritize measures that have readily available commercial plan benchmarks.

Process used to select quality measures

Measures were selected from final list of CCO incentive metrics. PEBB staff developed a proposal for incorporating measures into health plan contracts with Board guidance.

Method used to revise/update current quality measures

Measures are reviewed/updated annually to ensure continued alignment with CCO incentive metrics and continued prioritization of measures most directly relevant to PEBB’s insured population.

Frequency with which current quality measures are updated/revised

PEBB’s health plan contracts are renewed annually to coincide with the January 1 plan year start. Quality measures are reviewed and re-negotiated as part of this annual process. Mid-year updates can be made through contract amendments to meet critical business needs.

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Health Plan Quality Metrics Committee – May 2017

Attachment: Current health outcome and quality measures list – PEBB

Adolescent Well Care Visits

Alcohol or other substance misuse (SBIRT)

Emergency Department utilization

CAHSPS Access to Care

CAHPS Patient Experience with Care

Childhood Immunization Status

Colorectal cancer screening

Controlling high blood pressure

Depression screening and follow-up plan

Developmental screening in the first 36-months of life

HbA1c poor control

Effective contraceptive use among women at risk of unintended pregnancy

Follow up after hospitalization for mental illness

PCPCH enrollment

Timeliness of prenatal care

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Health Plan Quality Metrics Committee – May 2017

Oregon Educators Benefits Board (OEBB) Pu

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h Start date for current quality measures TBD – OEBB is currently reviewing and identifying measures for the 2017-20 medical/Rx

contracts

Performance measurement period (i.e., calendar year, etc.)

Measurement period will depend on the statistical requirements of the measure. Calendar year will probably be the most likely since most of the measurements under consideration use this measurement period (i.e. HEDIS, CAHPS, etc.). OEBB’s plan year is Oct 1 – Sept 30.

Number of measures in the measures set TBD Who/what do current quality measures apply to?

Health Plans contracted with OEBB and practitioners providing services through the health plans.

How are current quality measures used (or intended to be used)?

Measure the quality of healthcare services and health outcomes tied to these services. OEBB will attach fees-at-risk to certain measures based on Board guidance.

Statutory, regulatory or federal waiver language pertaining to the specific measures in the measure set (if any)

No applicable specific statutory, regulatory or federal waivers

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Key criteria (in brief) used to select current quality measures

• Measures applicable to OEBB population • Where possible, align with other state health program measures • Effectively measure performance and tied to financial incentives when appropriate • Measures address:

o Prevention o Chronic Conditions o Mental health o Lifestyle/Other (health risk factors, customer satisfaction, etc.)

Process used to select quality measures

• Proposed measures identified by OEBB staff/contracted carriers with input from select Board members

• Proposed measures reviewed, updated and recommended to Board by OEBB Strategies on Evidence and Outcomes Workgroup

• OEBB Board reviews and determines measures to be implemented Method used to revise/update current quality measures

TBD

Frequency with which current quality measures are updated/revised

TBD. Likely annual updates to coincide with health plan contract renewals.

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Health Plan Quality Metrics Committee – May 2017

OEBB Outcome/Quality Metrics under consideration

Category Measure

Prevention

Adolescent Well Care visits

Childhood immunization status

Influenza immunization for adults

Colorectal cancer screening

Developmental screening in the first 36 months of life

C-section rate or timeliness of prenatal care

Chronic condition

Controlling high blood pressure

HbA1c control

Diabetic medication adherence

Mental health Depression screening and follow-up plan

Depression medication management

Lifestyle/other

Emergency department utilization

CG CAHPS Patient Experience Measure (five measures)

Smoker/tobacco use registry

Body Mass Index (BMI) monitoring

Meaningful use of electronic medical record

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Health Plan Quality Metrics Committee – May 2017

Department of Consumer and Business Services – Oregon Health Insurance Marketplace Pu

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h Start date for current quality measures January 1, 2017 Performance measurement period (i.e., calendar year, etc.)

Calendar year

Number of measures in the measures set 42 Who/what do current quality measures apply to?

Providers, members, health plans

How are current quality measures used (or intended to be used)?

They are used to create a rating (out of 5 stars, with 3 summary indicators also displayed) for display on healthcare.gov when individuals are shopping for health insurance plans.

Statutory, regulatory or federal waiver language pertaining to the specific measures in the measure set (if any)

Section 1311(c)(3) of the Affordable Care Act directs the HHS Secretary to develop a system that rates QHPs based on relative quality and price. It also requires Marketplaces to display QHP quality ratings on Marketplace websites to assist in consumer selection of QHPs. Based on this authority, CMS established standards and requirements related to QHP issuer data collection and public reporting of quality rating information in every Marketplace. QHP issuers must submit quality rating information (specifically QRS clinical measure data and QHP Enrollee Response data) for its QHPs in accordance with CMS guidelines as a condition of certification and participation in the Marketplaces.

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Health-Insurance-Marketplace-Quality-Initiatives.html

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Key criteria (in brief) used to select current quality measures

Measures were selected to be used in scoring that will allow consumers to easily compare the quality of health care services and enrollee experience among health plans available to them during enrollment.

Process used to select quality measures

CMS consulted consumers and industry stakeholders during the measure selection process. Some measures were taken from HEDIS and some from an enrollee survey created by CMS based on CAHPS.

Method used to revise/update current quality measures

CMS revises the measures and then solicits comments from stakeholders before finalizing changes, including using a pilot program in 2017 to determine how useful the ratings were to consumers.

Frequency with which current quality measures are updated/revised

Yearly

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Health Plan Quality Metrics Committee – May 2017

Exhibit 1. 2017 Quality Rating System (QRS) Measures

Prenatal and Postpartum Care Adult BMI Assessment Proportion of Days Covered Annual Dental Visit Relative Resource Use for People with Diabetes (Inpatient Facility Index) Annual Monitoring for Patients on Persistent Medications Use of Imaging Studies for Low Back Pain Antidepressant Medication Management Weight Assessment and Counseling for Nutrition and Physical Activity for

Children and Adolescents Appropriate Testing for Children With Pharyngitis Well-Child Visits in the First 15 Months of Life (6 or More Visits) Appropriate Treatment for Children With Upper Respiratory Infection Well-Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis Breast Cancer Screening Cervical Cancer Screening Childhood Immunization Status (Combination 3) Chlamydia Screening in Women QRS Survey Measures Colorectal Cancer Screening Access to Care Comprehensive Diabetes Care: Eye Exam (Retinal) Performed Access to Information Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%) Aspirin Use and Discussion Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Testing Care Coordination Comprehensive Diabetes Care: Medical Attention for Nephropathy Cultural Competence Controlling High Blood Pressure Flu Vaccinations for Adults Ages 18-64 Follow-Up After Hospitalization for Mental Illness (7-Day Follow-Up) Medical Assistance With Smoking and Tobacco Use Cessation Follow-Up Care for Children Prescribed ADHD Medication Plan Administration Immunizations for Adolescents (Combination 2) Rating of All Health Care Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Rating of Health Plan Medication Management for People With Asthma (75% of Treatment Period) Rating of Personal Doctor Plan All-Cause Readmissions Rating of Specialist

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