OHA s Quality & Accountability Metrics: Measuring CCO Performance. State of Oregon Research Academy September 17, 2014

Transcription

1 OHA s Quality & Accountability Metrics: Measuring CCO Performance State of Oregon Research Academy September 17, 2014

2 Health System Transformation: Achieving the Triple Aim 2

3 Our Health System Transformation 3

4 Transforming the Health Care System Benefits and services are integrated and coordinated One global budget that grows at a fixed rate Metrics: standards for safe and effective care Local accountability for health and budget Local flexibility 4

5 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 5

6 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. 6

7 Measurement Strategy 7

8 Oregon Health Authority Accountability State Performance Measures Annual assessment of statewide performance on 33 measures. Ensure quality of and access to care for Medicaid beneficiaries does not degrade during transformation. Financial penalties to the state if quality goals are not achieved. 8

9 CCO Accountability CCO Incentive Measures Annual assessment of CCO performance on 17 measures. Measures selected by public Metrics & Scoring Committee. Compare annual performance against prior year (baseline). Measure specifications and Quality Pool methodology online at: 9

10 Quality Pool Quality Pool CCOs must meet either the benchmark or an improvement target for each of the 17 measures to earn quality pool funds. Quality pool = 2% of actual CCO paid amounts in Will increase to 3% in Quality Pool methodology online at: 10

11 Measure Selection: A Public Process Metrics & Scoring Committee 9 member committee, public process, select measures and set benchmarks Metrics Technical Advisory Workgroup Ad hoc workgroup with CCO representatives, operationalize metric specifications, make recommendations to Committee Committee online at: 11

12 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 12

13 How are we doing? 2013 results 13

14 14

15 15 How did CCOs do?

16 Decreased emergency department (ED) utilization ED visits decreased 17 percent since The cost of providing services in EDs decreased by 19 percent. 16

17 17 ED utilization by race & ethnicity

18 18 ED utilization by CCO

19 Increased developmental screening Developmental screening increased by 58 percent since

20 20 Developmental screening by race & ethnicity

21 21 Developmental screening by CCO

22 Increased primary care Outpatient primary care visits for CCO members increased by 11% Spending for primary care and preventive services are up 20% Enrollment in patient centered primary care homes has increased by 52% since baseline. 22

23 23 Patient Centered Primary Care Home (PCPCH) enrollment by CCO

24 24 What s Next?

25 Future Metrics Work Ongoing reporting monitor expansion population. Sub-population analysis: Race, ethnicity, language and disability Severe and persistent mental illness Specific diagnoses (e.g., chronic conditions, addictions) Operationalizing new measures: dentalsealants, tobacco use, effective contraceptive use. Measures for long-term care and early learning services. Cross-payer analysis of incentive measures (PEBB, OEBB, Commercial) 25

26 For more information All about CCOs: Measure resources (quality improvement focus): Other great data from the Office of Health Analytics: How to make dumbbell plots in Excel (our awesome data vizconsultant): 26

27 Questions? Sarah Bartelmann Metrics Coordinator