health aspects of kindergarten readiness technical workgroup … · 2020. 6. 27. · improvement...

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP SEEKS YOUR INPUT

Healthy kids are better able to learn and succeed in school. The health care system plays an

important role in helping prepare children for kindergarten. Children’s Institute, in collaboration

with the Oregon Health Authority and with technical expertise from the Oregon Pediatric

Improvement Partnership, is convening a Health Aspects of Kindergarten Readiness Technical

Workgroup from March – November 2018. The purpose of the workgroup is to recommend one

or more measures of the health aspects of kindergarten readiness that could be applied to

Coordinated Care Organizations (CCOs) as incentive metrics. The recommendations are

intended to drive behavior change and quality improvement for health providers and the health

care system, as well as catalyze investments and collaboration that will contribute to improved

kindergarten readiness for children.

The workgroup is considering metrics that span preventive care as well as follow-up services to

address risks identified in the areas of physical, behavioral, and oral health. More information on

the metric recommendations being considered can be found in our meeting materials on the

workgroup webpage: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx.

We are seeking stakeholder input to understand the potential impact as well as relative

advantages and disadvantages of the metric recommendations we are exploring. If you are an

Oregon Health Plan member or if you serve young children and families as a health care

provider or in early learning and family support programs, we would like to hear from you! We

are also seeking input from health care, public health, and education stakeholders. The

workgroup will consider your input as we navigate other important considerations that will

impact our recommendations.

To submit public comment, you can attend the workgroup’s upcoming meeting on Friday,

October 26th, 2018 from 9.30am – 12:30pm. Meeting location and call-in information can be

found on the workgroup webpage: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-

Health.aspx.

You can also email your public comment at any time to [email protected]. Public comment

will be reviewed and considered through Friday, October 26th, 2018.

Oregon has an exciting opportunity to become the first state to incentivize the health care

system to contribute to improved kindergarten readiness, and your input can help ensure this

workgroup makes meaningful recommendations.

http://www.childinst.org/

http://www.oregon-pip.org/index.html

http://www.oregon-pip.org/index.html

https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx



mailto:[email protected]

HEALTH ASPECTS OF KINDERGARTEN READINESS TECHNICAL WORKGROUP

1

• Formation and charge of the Health Aspects of

Kindergarten Readiness Technical Workgroup

• Workgroup process and progress

• Current options being explored

• Opportunity for feedback

Contents in Overview Slideshow

2

3

Workgroup

Formation

and Charge

Strong interest due to:

• Data demonstrating poor educational outcomes for Oregon’s children

• Research highlighting the close and bidirectional relationship between health and

kindergarten readiness

• Policy vision for health and early learning system alignment

Workgroup Formation

4

2009 2010 2011 2012 2013 2014

Oregon Health

Authority created

(HB 2009)

CCOs created

(HB 3650)First CCOs

launched

CCO Transformation Center

created

Early Learning

Council created

(SB 909)

Early Learning

Hubs created

(SB 4165)

Early Learning

Division

established

(HB 3234)

First Early

Learning Hubs

launched

Shared Goal:

Kindergarten

Readiness

• 2014–2015: The Child and Family Well-being Measures Workgroup developed initial

measurement recommendations for child and family well-being, including kindergarten

readiness.

• 2015–2017: The Metrics and Scoring Committee (M&SC) remained engaged on the topic of

developing a kindergarten readiness metric.

• May 2017: The M&SC voted to sponsor a Health Aspects of Kindergarten Readiness

technical workgroup, launching the partnership between Children’s Institute and the Oregon

Health Authority.

• July 2017: The Health Plan Quality Metrics Committee (HPQMC) approved the workgroup

formation.

• July 2017–February 2018: Workgroup planning and preparation, including family focus

groups, hiring consultants, recruiting for members.

• March 2018–Present: Workgroup convening.

Workgroup Formation

4

Workgroup Charge

6

What is the health sector’s role and responsibility for achieving

kindergarten readiness for Oregon’s children?

Recommend one or more health system quality measures

that:

• drive health system behavior change, quality improvement,

and investments that meaningfully contribute to improved

kindergarten readiness

• catalyze cross-sector collective action necessary for

achieving kindergarten readiness

• align with the intentions and goals of the CCO metrics

program

Workgroup website:

https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-

Health.aspx

Health Sector’s

Role

Kindergarten Readiness

Diverse Workgroup Composition

7

• Workgroup roster includes:

• CCO representatives

• Pediatric care providers

• Behavioral health

• Early learning hub and early learning program representatives

• Health care quality measurement expertise

• Health care consumer representatives

• Support team includes Children’s Institute, Oregon Health Authority, and

consultants

• Facilitator: Diana Bianco, Artemis Consulting

• Measurement Expertise: Colleen Reuland, Oregon Pediatric Improvement

Partnership

How do health services support school readiness?

• Take time to build trust, listen to families, and ask about concerns

• Provide comprehensive prenatal and postpartum care, and parental health services (especially mental health)

• Monitor child development, provide timely immunizations, and ensure proper nutrition

• Make referrals to needed health, early learning and family support services

Centering Family Voice

8

How can health services continue to improve to support school readiness?

• Spend more time with families to develop trusting relationships

• Share expertise, information, and guidance about supporting learning at home

• Identify and communicate developmental concerns earlier, provide referrals to needed services, and follow up

• Increase local access to health services (especially in rural areas)

• Approach health care holistically across the life span, and support parents and caregivers in pediatric care

9

Workgroup

Process and

Progress

9

10

Workgroup Timeline

March - May

• Reviewed background on CCO incentive measure program and kindergarten readiness definitions and domains

• Developed conceptual framework for health aspects of kindergarten readiness

• Developed measure criteria

June - August

• Reviewed and assessed existing metrics that could be implemented in near-term

• Discussed interest in new metrics for development

September -November

• Explore options for measurement proposals

• Build consensus on final recommendations

• Present final recommendations to Metrics and Scoring Committee

Slides for each of the meetings can be found here: https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx

11

HAKR Workgroup: Conceptual Framework for Health Aspects of Kindergarten

Readiness

12

HAKR Workgroup: Measure Criteria

13

HAKR Workgroup: If Multiple Metrics Selected

14

• Reviewed Current CCO Incentive Metrics

• Prioritized areas within the conceptual framework for measure exploration

• Reviewed and assessed Metrics Ready Now for proposal as a CCO Incentive Metric that

address a priority area identified by the HAKR workgroup (June Meetings)

• Review and assessed Existing Metrics that address a priority area dentified by the

HAKR workgroup, but that need development work in the next 1-2 years in order to be

ready for proposal as a CCO Incentive metric (July-August Meetings)

• Of these metrics, HAKR workgroup prioritized metrics to move forward on assessing

for consideration

• Discussed interest in New Metrics, Development and piloting needed (August

Meeting)

• Discussed options for using a combination of metrics (September Meeting)

Workgroup Progress to Identify Potential Options

Slides for Meeting on the Website:


15

Current CCO Incentive Metrics in HAKR Conceptual Framework

16

HAKR Workgroup: Priority Areas of Interest

17

Metric

Components

Under

Consideration

19

See attached

document

providing an

overview of the

metrics under

consideration.

Direction for Recommendations

20

Goal: Balance long-term vision for transformative work on kindergarten readiness with

current momentum and sense of urgency

HAKR is a multi-faceted concept, so it is not sufficient to recommend only one metric

Instead, a HAKR Measurement Strategy is needed that Recommends Multiple Metrics

o Input from Metrics & Scoring and M&S Tag noted caution in using a multi-part bundle metric and

potential value in rolling out different metrics at different time periods.

o Strategy needs to take into account the limited size of the CCO incentive measure set, and

ultimate need for HPQMC adoption of any future CCO incentive measures

• Factors to consider in picking which of the 12 metric options to propose to M&S as part of HARK

Measurement Strategy:

o Consideration of HAKR measure score

o Use of HAKR Workgroup Criteria

o Clear focus from the workgroup throughout on driving improvements in social-emotional

development

21

Required Criteria

• Reportable at the CCO level

• Annual Reporting

Criteria Considered

Technical Measure Criteria

• Evidence-based and scientifically acceptable

• Has a relevant benchmark

• Not greatly influenced by patient case mix

Program-Specific Criteria

• Consistent with goals of program and CCOs

• Useable and relevant

• Feasible to collect

• Promotes increased value

• Present an opportunity for quality improvement

• Transformative potential

• Sufficient denominator size

Criteria Considered for the Measurement Set

• Representative of array of services provided by program

• Representative of diversity of patients served by program

• Not unreasonably burdensome to payers or providers

Key Consideration: CCO Incentive Metric Set

Factors Used To Consider Which Metric Components to

Include in the Multi-Metric Strategy

23

• HAKR Workgroup measure criteria if multiple metrics are included:

1. Set of metrics is parsimonious and limited in number of individual components.

2. Includes metrics which, in combination, measure the desired outcome by addressing the array of

services that impact a child’s KR.

3. Includes metrics that utilize various data sources.

4. Includes measures with the most transformative potential to drive health system change and

stimulate cross-sector collaboration.

Additional factors HAKR Workgroup may consider in identifying components:

• Includes a focus on addressing social-emotional health

• Builds momentum for across-sector collaboration and integration within CCOs service lines (physical, behavioral

and dental).

• Set of metrics addresses different populations within 0-5 (e.g. not all metrics for 0-1 vs. 3-6)

• Includes at least one metric that address the full population and a metric that focused on follow-up for children

with specific needs.

• Balances urgency and current opportunity with desire for transformation (e.g. includes at least one metric that can

be implemented in 2020)

Public Comment

24

• To submit public comment, you can attend the workgroup’s upcoming meeting on

Friday, October 26th, 2018 from 9:30 – 12:30pm. Meeting location and call-in

information can be found on the workgroup webpage:

https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx.

• You can also email your public comment at any time to [email protected].

Public comment will be reviewed and considered through Friday, October 26th, 2018.

• Public comment on any part of the HAKR Workgroup activities since March.

• Some areas where input specifically be valuable:

o Input on the 13 specific metrics under consideration and your perceptions on

strengths, barriers, and/or measurement and implementation issues to consider if

the metric was proposed.

o Input on timing of recommendation of specific metrics.

Summary of Metric Options Under Consideration by the Health Aspects of Kindergarten Readiness Workgroup

October 2018 1

The attached visual provides a high-level overview of the individual metrics under consideration by the Health Aspect of Kindergarten Readiness Technical (HAKR) workgroup. One or more of these metrics may be proposed for adoption by the CCO Metrics and Scoring Committee (M&S), the public body which chooses the measures included in the CCO Quality Incentive Program (https://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-Scoring-Committee.aspx). Workgroup meeting dates at which specific measure were discussed are noted below; meeting materials, including audio recordings, are on the workgroup webpage (https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx).

1) Preventive Dental Visits for Children Aged 1-5 Description: Percentage of children ages 1-5 on Medicaid who received preventive dental services from a dental provider in the year. Measure Developer: CMS EPSDT – Form 416, Modified by OHA Data Source: Medicaid claims HAKR Workgroup Meeting at Which Measure Properties Described in Detail: May 25th, 2018 Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 10.8 (out of 13)

Relevant Information Related to HAKR Measure Criteria:

Evidence-Based or Aligned with Clinical Recommendations: Measures align with Bright Futures clinical recommendations.

Actionable: CCOs can impact access to care, through physical health services and additional outreach.

Outcome-Related: Poor oral health can significantly impact a child’s ability to learn in school.

Engages Health System: Promotes the health system’s awareness, engagement, and role in ensuring children receive dental health care early in their life.

Understandable to Families: Communicates to families the importance of oral health as part of child health.

Addresses Social Determinant: Poor oral health linked to many poor long-term health and education outcomes.

Promotes Cross-Sector Collaboration: Metric could promote collaboration across physical health care and dental care providers if primary care providers who see children more often are leveraged for education and outreach (and vice versa). Opportunities to engage early childhood settings on outreach as well.

Able to Identify Inequities: The measure is able to be disaggregated by race, gender, geography or other child factors. Barriers to access to dental health providers has been noted in rural regions.

Additional Considerations:

Fills gap in M&S measure set focused on dental service line within CCOs, and aligns with measure used by the Oregon Educators Benefit Board.

2nd highest HAKR workgroup measure criteria score. Of the metrics ready for adoption now, highest mean HAKR score.

Relevant Data:

In 2015, 20.4% of children on Medicaid ages 0-2 received preventive dental services from a dental provider.

In 2015, 52.6% of children on Medicaid ages 3-5 received preventive dental services from a dental provider.

Data About Need Derived from Early Learning Division Strategic Plan:

52% of children ages 6-9 in Oregon have tooth decay.

Tooth decay is one of the most prevalent chronic conditions of childhood and can lead to problems with eating, speaking, playing, and learning.

In 2013, Oregon ranked last out of 50 states regarding children having at least one preventive dental visit during the year.

https://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Metrics-Scoring-Committee.aspx



October 2018 2

2) Well-Child Visits for Children Ages 3-6 Description: Percentage of children ages 3-6 that had one or more well-child visits with a primary care provider (PCP) in the year. Measure Developer: National Committee for Quality Assurance (NCQA) Data Source: Medicaid claims HAKR Workgroup Meeting at Which Measure Properties Described: May 25th, 2018 Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 8.62 (out of 13)


Evidence-Based or Aligned with Clinical Recommendations: Measures align with Bright Futures clinical recommendations related to well-child visit periodicity. Addresses a gap in current metrics for care for children 3-6.

Actionable: Access to primary care is first step in ensuring access to developmental screening and follow-up supports needed to ensure children are ready for kindergarten.

Understandable to Families: Communicates to families that preventive care, received annually through age six, is important. That said, it may not be clear why well-child visits and the care provided in those visits impact kindergarten readiness.

Able to Identify Inequities: The measure is able to be disaggregated by race, gender, geography or other child factors.


Fills gap in M&S measure set for population of children 3-6.

Metric is focused on access to well-visit, but the claim does not provide information that would allow for assessment of the quality of care provided in the visits. If adopted, opportunity to focus on the elements that should occur in well-child visits, including a focus on social-emotional health, through metric guidance document and other technical assistance.

Relevant Data:

In 2017, 60% of children on Medicaid ages 3-6 received one or more well-child visits.

By comparison, 73% of children on commercial health insurance, 70% of children on insurance through OEBB, and 68% of children on insurance through PEBB received one or more well-child visits.

3) Two-Part Bundle Metric: (1) Preventive Dental Visits and (2) Well-Child Visits HAKR workgroup members proposed the idea of a bundle and/or composite metric that could be comprised of both metrics #1 (Preventive Dental Visits) and #2 (Well-Child Visits). If this measurement concept were identified as a priority for inclusion in the measure recommendations to M&S, then a number of options for the metric would need to be explored and confirmed before proposal to M&S. Options could include, but are not limited to:

A single, bundled measure of the two separate metrics with two separate denominators, and different benchmarks for each component (must meet both benchmarks to achieve single measure) OR

A measure that examines the proportion of children 3-6 years old who each had preventive dental services AND a well-child visit (single denominator, one benchmark).


October 2018 3

Metrics #4-6 are metrics that have been developed and piloted, but would need additional measure development work and policy and payment alignment to support any proposal to adopt as CCO incentive metrics.

4) Maternal Depression Screening in Child’s Visit in First Six months of Life Description: Percentage of children who turned 6 months of age during the year who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life Measure Developer: National Committee for Quality Assurance. Based on NQF Endorsed Metric #1401 Data Source for Version Presented: Medicaid claims aligned with current use in North Carolina Medicaid HAKR Workgroup Meeting at Which Measure Properties Described: July 27th, 2018 Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 10.3 (out of 13)


Evidence-Based or Aligned with Clinical Recommendation: Bright Futures recommends maternal depression screening at 1, 2, 4, and 6 months.

Outcome-Related: Parental health is associated with attachment and related child health and development outcomes. Maternal depression has been associated with increased emergency room visits for the child. Further work needed to understand if increased screening leads to increased receipt of services to address the depression and if those services modify impact on the child’s development.

Engages Health System & Engages Families: Work would be needed to contextualize and communicate about the measure, but it could enhance understanding of the impact of parent/caregiver health on child development.

Family Priority: In focus groups, families shared that they want the health care system to approach health holistically, across the lifespan and across multiple generations in a family.

Family-Centered: Could enhance communications with the family about importance of their health.

Promotes Cross-Sector Collaboration: Metric is anchored to screening. If follow-up focused on, will require collaborative efforts with community-based and health care providers that support parents with depression. Past efforts have shown a lack of capacity in services to address families identified.


Fills gap in M&S measure set for metrics that address parental health.

Complements new postpartum measure

Untreated maternal depression can impact attachment, which can impact social-emotional development.

Metric is focused on screening and does not include a focus on follow-up.

Relevant Data:

Oregon data on rates of maternal depression screening (CPT 96161) in 2017: 13.5% for Medicaid and 14.2% for commercial insurance (All Payer All Claims database)

North Carolina data for 4th quarter of 2017: 82% at the 1 month visit

HAKR Staff Team High-Level Summary of Work Needed to Develop the Metric as a CCO Incentive Metric

Technical properties that need to be addressed:

Confirm sampling specifications regarding continuous enrollment and visit criteria

Confirm the number of screens that should occur. Feasibility of collecting the metric:

As proposed, based on claims data, it should be relatively feasible to be collect. Degree to which the policies and payments are aligned with the metric:

Degree to which the policies and payments are aligned with the metric: need clarification around coverage of 96161-Edinburgh Postnatal Depression Scale Z13.89, and alignment of the use of the code with Bright Futures Recommendations. Screening for postpartum depression is intended to be covered by the Oregon Health Plan as part of diagnostic work-up, at either a parent or a child’s visit.

The Health Evidence Review Commission reviewed this issue in September which resulted in clarification of coverage of these screenings. Providers will need to be educated about the clarification as well as pathways to services for parents with symptoms of post-partum depression.


October 2018 4

5) Follow-up to Developmental Screening Description: Percentage of children screened with a standardized developmental screening tool and identified at-risk for developmental, behavioral and social delays who received follow-up steps to address delays identified. Three versions of the metric are available that vary according to what follow-up counts based on level and type of risk identified. Measure Developer: Oregon Pediatric Improvement Partnership Data Source for Version Presented: Medicaid charts, Electronic Health Record reported metric HAKR Workgroup Meeting at Which Measure Properties Described: July 27th, 2018 Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 11.5 (out of 13)


Evidence-Based or Aligned with Clinical Recommendation: Bright Futures recommends screening and follow-up.

Outcome-Related: Some evidence that early intervention services can address delays before kindergarten entry.

Engages Health System & Engages Families: Work would be needed to contextualize and message, but the metric could help explain the value of follow-up to screening, the need for services to address delays identified early, and the role the health system plays in connecting families to needed services.

Family Priority: Developmental screening and follow-up to screening were identified by families in focus groups.

Promotes Cross-Sector Collaboration: Given a number of the follow-up services are not within primary care, would require extensive collaborative work across the sectors in which follow-up services exist.

Supports Equity: Within quality improvement work and within Early Intervention data, observed disparities in screening and follow-up by race/ethnicity.


Fills gap in M&S measure set for metrics that address follow-up services.

Highest HAKR workgroup measure criteria score.

M&S and HPQMC have already identified desire for metric on this topic.

Includes a focus on social-emotional health and children identified with self-regulation and problem solving delays.

Could replace current developmental screening metric.

Concerns about development work needed, burden of an EHR-based metric, and consideration of timing of when this would be proposed.

Relevant Data:

Medicaid Performance Improvement Project within eight Medicaid Managed Care Organizations in OR: Overall, only 40% of children identified at-risk received follow-up; large variation in rates by Managed Care Organization: 0-63%.

Practice-Level Data Collection: Medical chart reviews as part of quality improvement projects; collected in seven practices (currently in process with five more) with varied characteristics, electronic medical records, and patient populations: Baseline ranges: 30-68% received follow-up. For a majority of the practices the rates were between 29-40% that received follow-up.


Technical properties of the metric that need to be addressed:

Confirm version to use for the CCO incentive metric.

Develop EHR reported specifications based on medical chart review specifications.

Develop standardized specifications for what counts as follow-up (numerator for the metric).

Develop specifications for other developmental screenings tools that are not the ASQ. Addressing feasibility of collecting the metric:

CCOs will need to work with practices on documentation in their medical charts about the screen result (used to identify the denominator) AND the follow-up (numerator).

Practice-level outreach and training on follow-up aligned with the metric. Degree to which the policies and payments are aligned with the metric:

Bright Futures recommendations only clearly specify referrals to Early Intervention (EI) and to a developmental behavioral pediatrician for evaluation.

Current work with Oregon Department of Education to clarify EI referrals relative to ASQ score.

Variation in availability and capacity of services included in the follow-up metric.


October 2018 5

6) Mental Health Utilization for Children Ages 0-6 (Behavioral Health, Dyadic Services for Children and Their Parent) Description: Percentage of children who received a behavioral health service. Various options for the metric were presented that include examining behavioral assessments, behavioral health services, and utilization of both. Behavioral health services for children in the first five years are dyadic in nature, with partnership, counseling and coaching with the parent being a critical element. This metric does include, but is not limited to, Health and Behavior Assessments, Child and Parent Psychotherapy (CPP) and Parent Child Interaction Therapy (PCIT). Included are claims for services behavioral health staff internal to a primary care clinic could provide. Measure Developer: National Committee for Quality Assurance, with significant modifications made by OHA/OPIP team to be relevant and applicable for children 0-5 and dyadic therapies Data Source for Version Presented: Medicaid claims HAKR Workgroup Meeting at Which Measure Properties Described: August 27th, 2018 Mean Score on HAKR Measure Criteria When Assessed by Workgroup Members: 9.40 (out of 13)


Evidence-Based or Aligned with Clinical Recommendation: Metric includes assessments and services with evidence of validity and effectiveness. Includes dyadic therapies for children and their parents that improve attachment, social-emotional health, and resilience.

Outcome-Related: Specific services included in the metric have evidence of impact on a child’s social-emotional regulation, which is correlated with ability to learn and interact in a classroom setting.

Engages Health System: Engages the health system in the role of social-emotional health and importance of these services.

Engages Families: Anchored to dyadic therapies that require engagement of family and buy-in of the family. Potential to educate and inform families about the importance of early social-emotional health.

Family-Centered: A majority of the services are dyadic in nature, so they require partnership and engagement of the parent.

High Impact and Transformative: Many stakeholders, including early learning and K-12, have noted the importance of addressing mental health.

Promotes Cross-Sector Collaboration: To be successful would require primary care, internal behavioral health, specialty mental health, and building capacity within each sector.

Supports Equity: There are disparities in availability of internal behavioral health and mental health services by region and disparities in utilization of services reported by race/ethnicity.


Fills gaps in HAKR conceptual framework.

Fills gap in M&S measure set for this service line (none for children within behavioral health).

Focus on services for children with or at-risk for social-emotional issues.

Anchored to dyadic therapies that often address social determinants of health in the family.

Concerns that it is a population-based metric and could create a focus on assessments and not services.

Concerns about lack of workforce and capacity for early childhood mental health services in the state.

Relevant Data:

Service benchmark: 12-16% of children ages 0-6 have a mental health condition that would benefit from mental health services

CCO range for children who received an assessment or services: 4.5-9.3%.


Technical properties of the metric that need to be addressed:

Finalize specific codes to be included and obtain input and guidance on inclusion of assessment services in the metric.

Obtain input and review by various CCOs and key stakeholders in the state.

Clarify and address benchmark rates. Addressing feasibility of collecting the metric:

Metric is based on claims data and is relatively feasible to collect. Degree to which the policies and payments are aligned with the metric:

Metric is aligned with the services outlined in OHA’s 0-5 diagnostic crosswalk for mental health services.

Opportunity to clarify policies and payments for internal behavioral health services within primary care settings.


October 2018 6

7) Expand Existing Depression Screening and Follow-Up Metric

Members of the HAKR staff team have raised the option of expanding the existing depression screening and follow-up CCO incentive metric to include children under 1. The current CCO incentive metric is the percentage of patients ages 12 and older screened for depression using an age-appropriate standardized tool AND if positive, had follow-up plan is documented on the date of the positive screen. It is an EHR reported metric. The proposal from the team is to expand the age group to include children 6 months old or in the first year of life.

8) CCO Attestation Metric This metric would be based on CCO reporting (e.g., via an attestation form) and demonstration of specific transformative tasks such as cross-sector activities, policy and payment changes, and system- and practice-improvements to impact the health aspects of kindergarten readiness. An integral component of the attestation metric would be the examination of data and development of systems, measurement methods, and processes that would allow for future feasible quality measurement focused on cross-sector activities and kindergarten readiness. Based on input and direction from the HAKR workgroup, the proposed CCO attestation metric would include a priority focus on the factors and systems needed to address social emotional health in young children. Options for potential specific elements to be included in the CCO attestation metric will be presented at the October 26th, 2018 HAKR technical workgroup meeting (https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/KR-Health.aspx).

Metrics #9-12 are metric concepts that were identified as priority for new development and work. These concepts were not assessed using the HAKR measure criteria given they are topic areas and do not have available and standardized measurement specifications Therefore, there would need to be development work to create a reliable, valid metric that could be proposed for adoption as a CCO incentive metric, including work to develop technical properties of the metric, pilots of the metric to address the feasibility, reliability and validity, and alignment of payments and policies for the metric. Below is a high-level summary of the measurement concepts discussed and identified by the HAKR workgroup.

9) Social-Emotional Screening HAKR Workgroup Meeting at Which Measure Concept was Discussed: August 27th, 2018 The concept of the metric is to assess whether children 3-6 years old were screened for their social-emotional development. A metric had been assessed by the HAKR workgroup that was based on medical chart review and specific to only one type of social-emotional screening tool. The HAKR workgroup discussed the idea of creating a metric that could potentially be based on claims data, or if needed EHR-based data, to assess whether a child was screened for social-emotional development (in the context of a well-child visit) with a wider array of tools, such as the Ages and Stages Questionnaire-Social Emotional or the Pediatric Symptom Checklist.

10) Multi-Part Bundle of Preventive Care HAKR Workgroup Meeting at Which Measure Concept was Discussed: August 27th, 2018 HAKR workgroup members proposed the idea of a bundle and/or composite metric that is comprised of multiple metrics that include #1 (Preventive Dental Visits), #2 (Well-Child Visits), #9 (Social Emotional Screening)), and a metric on use of behavioral health services. If this measurement concept were identified as a priority for inclusion in the measure



October 2018 7

recommendations to M&S, then a number of options for the metric would need to be explored and confirmed before proposal to M&S. Options could include, but are not limited to:

A bundled measure of the three or four separate metrics with three/four separate denominators and different benchmarks for each component OR

A measure that examines the proportion of children 3-6 years old who had each of the three/four services in the measurement year (single denominator, one benchmark).

11) Disparities in Birth Outcomes HAKR Workgroup Meeting at Which Measure Concepts Were Discussed: June 26th, 2018 and July 27, 2018

HAKR workgroup members noted the importance of addressing disparities in birth outcomes and developmental origins of health and disease given their long-term impacts on health and learning for children. There are significant disparities in birthweight and birth outcomes by race/ethnicity. The HAKR workgroup reviewed two metrics, unexpected newborn complications, and low birthweight. For both of these metrics there were issues with how the metric was measured and/or the data source used for the metric and application at a CCO-level. Given that addressing low birthweight and the various and complex factors that contribute to low birthweight would require transformative action within the health system and addressing developmental origins of health, the HAKR workgroup felt it is important to highlight the need for measurement development in this area. Therefore, the HAKR Workgroup Final Report will include a recommendation to the Oregon Health Policy Board and the Health Equity Measures Workgroup about the importance of addressing disparities in birth outcomes and developmental origins of health and disease.

12) Quality of Well-Child Visits HAKR Workgroup Meeting at Which Measure Concept was Discussed: August 27th, 2018

HAKR workgroup members noted the limitations of the well-child visit metrics as they assess access to well-child care, not the quality of care provided during the well-child visit. The HAKR Workgroup Final Report will include a notation of the limitations of access metrics and the need to also focus on the quality of care provided during those visits. A HAKR workgroup member proposed a metric aimed at assessing the quality of the well-child visit. This metric would be based on data from the EHR, and comprised of eight specific areas meant to indicate a high quality well-child visit. The metric would assess whether at least half of the eight topic areas were addressed during the well-child visit, and whether risks or delays identified were followed up. If this concept were explored, additional metrics that could be based on EHR specifications, claims for specific components of the well-child visit, or parent-report through a survey, could be examined.

13) Quality of Care for Children and Youth with Special Healthcare Needs (CYSHN) HAKR Workgroup Meeting at Which Measure Concepts were Discussed: June 26th, 2018 and July 27, 2018

An important population of focus in the HAKR conceptual framework is children with special healthcare needs, given this population will need unique and potentially additional supports and resources from the healthcare system to be ready for kindergarten. The HAKR workgroup reviewed two survey-based metrics focused on CYSHN, the Family Experience of Coordinated Care Survey (FECC) and the Pediatric Integrated Care Survey (PICS). FECC and PICS require new data collection with a new survey completed by parents. This would require new resources that pose a significant barrier to adoption of the metric. Secondly, CCOs have found challenges in using data based on the CAHPS (a survey currently in the incentive program) due to the survey administration process, sample of respondents, and other factors. Innovative sampling and administration methods may enhance usability, but require new development work. Lastly, there may be options to disaggregate and stratify existing claims-based metrics for specific populations of CYSHN using methodologies currently being developed by the Oregon Health Authority. Therefore, the HAKR Workgroup Final Report will include a recommendation to Health Plan Quality Metrics Committee (HPQMC) that supports HPQMC’s focus on developing valid, meaningful and feasible metrics focused on CYSHN, including a feasible and meaningful patient experience survey specific to CYSHCN.

health aspects of kindergarten readiness technical workgroup … · 2020. 6. 27. · improvement...

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