Metrics & Scoring Committee March 20, 2020
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Metrics & Scoring Committee
March 20, 2020
Location:
Webinar-based meeting
9:00 a.m. to 12:00 p.m.
Item
Metrics & Scoring Committee Materials and Audio Recording
All meeting materials referenced in these notes, including presentation slides, are available online at:
https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/Metrics-Scoring-Committee.aspx. To listen to the
recording of the Metrics & Scoring Committee (MSC) meeting in its entirety click here. Agenda items can be
reviewed at time stamp listed in the column below.
Welcome and Updates
Present (all by phone):
Committee members present: Chair Amit Shah, Vice-chair Summer Prantl, Jennifer Clemens, Aileen
Duldulao, Katy Halverson, David Ross, Brian Sandoval, Roshanthi Weerasinghe.
Committee members absent: Steven Kassakian.
Oregon Health Authority (OHA) staff: Will Clark-Shim, Pete Edlund, Sara Kleinschmit, Stacey Schubert,
Valerie Stewart, Kristin Tehrani, Frank Wu, Kate Lonborg.
Guests/others: Thomas Potter (Eugene Pediatrics), Elaine Schweitzer (Umpqua Health).
UPDATES
Chair Amit Shah introduced new MSC measurement expert member Aileen Duldulao.
Minutes: Summer Prantl moved to approve the February minutes as written, Amit (and Brian Sandoval)
seconded. Aileen abstained, all others voted aye.
Amit noted that several MSC members have terms ending in July 2020 and are eligible to renew. Members
are asked to let Sara Kleinschmit know if they are planning to reapply for continued membership.
HPQMC Update 8:55
Amit Shah spoke about the March 12th Health Plan Quality Metrics Committee (HPQMC)
meeting, at which the MSC chairs (Amit and Summer) presented MSC’s recommendations from
the February MSC meeting. HPQMC then approved the 2021 measure set, with the addition of
five measures, including the two transformative measures that MSC endorsed, and the removal
of two, for a total of 55 (added and removed measures listed in slides). They also approved a
new review process and set of criteria for transformative measures.
Developmental Measures 12:30
Sara Kleinschmit provided the update on developmental measures. The Kindergarten Readiness
measurement strategy of OHA and partners at Children’s Institute and the Oregon Pediatric
1Metrics & Scoring Committee
March 20, 2020
Location:
Webinar-based meeting
9:00 a.m. to 12:00 p.m.
Improvement Partnership continues. The Social Determinants of Health measure workgroup
members have been selected and are slated to meet in April. Sara also noted that the National
Center for Quality Assurance will serve as a national advisor for this work.
Public Comment 14:05
Several pieces of written testimony were submitted and can be found online in the meeting
listing:
• Dr. William J. Koenig, Yamhill County in relation to the developmental obesity measure.
• Pacific Source CCO, in relation to continuous enrollment criteria
• Thomas Potter of Eugene Pediatrics, regarding COVID-19 and metrics impact.
• Children’s Health Alliance, regarding COVID-19 and metrics impact.
Julie Harris (Children’s Health Alliance) spoke about concerns regarding the impact of COVID-19
response on the 2020 CCO Incentive Program (this supplemented written testimony from the
Children’s Health Alliance).
Continuous Enrollment and 2020 24:40
Sara Kleinschmit noted that due to new contract arrangements beginning in January 2020 with
CCO 2.0, there was concern that new CCOs may find themselves with very few (or zero)
members qualifying for the denominator of some CCO incentive measures. The program does
not currently include a rule on how to treat measures for which no members qualify for
inclusion in the denominator after continuous enrollment criteria are applied.
In addition, there was also concern for any CCOs which might experience significant
membership changes, and how this would impact year-on-year comparisons used to assess
whether a CCO does or does not meet a measure.
Given these concerns, and as one approach to addressing these issues might be changes to the
measure specifications (specifically the continuous enrollment criteria), in November 2019 the
MSC unanimously voted to allow the continuous enrollment discussion to continue into early
2020, with a final decision needed on any changes to continuous enrollment for the 2020
measurement year made by March 31, 2020.
Sara Kleinschmit provided background on previous MSC decisions regarding small denominators
and significant membership change, and OHA’s recommendations for changes MSC could make
to address these circumstances. These recommendations are informed by extensive
consultation with the CCO metrics Technical Advisory Group (TAG) from September 2019 –
February 2020, including a survey of CCOs. Though informed by this consultation, the OHA
2Metrics & Scoring Committee
March 20, 2020
Location:
Webinar-based meeting
9:00 a.m. to 12:00 p.m.
recommendations do not necessarily represent the views of the TAG, or any particular CCO. The
complete list of recommendations can be found in the meeting materials and includes details on
the options referenced below.
In terms of previous M&SC precedent related to these issues:
• June 2013: The Committee considered a recommendation from OHA & TAG
• Omit measures with small denominators (nMetrics & Scoring Committee
March 20, 2020
Location:
Webinar-based meeting
9:00 a.m. to 12:00 p.m.
• In 2018, Health Share had its membership increase by about 54%, WVCH by about 6%,
and Yamhill by about 100 members, when they accepted new members after FamilyCare
CCO closed its Medicaid line-of-business.
Sara noted that in terms of the current situation, after membership enrollment decisions were
finalized in early 2020, OHA was able to review all 2020 incentive measures and anticipates that
no CCO will have a measure in which there are absolutely zero members (as was the fear before
these data became available).
It was also noted that because continuous enrollment for the two immunization measures is tied
to a member’s birthday, in 2020 the only members who would be included in these measures
for PacificSource – Marion/Polk and PacificSource – Lane CCOs are those with birthdays from
mid-November 2020 – December 31, 2020. OHA reviewed current members of these CCOs
meeting age criteria for these measures, and with birthdays in the timeframe above (meaning
they would be included in the final denominator for the measure). Even with assumptions
regarding member attrition, both CCOs should have at least 100 members in each of these
measures for 2020.
Sara noted that after the February Metrics TAG meeting and discussions with PacificSource, it
became clear that CCOs generally prefer a program structure change option as opposed to
modification of continuous enrollment criteria for individual measures. As such, OHA
recommendations focus on program change, rather than modifications to continuous
enrollment. Remembering that earning 100% of a CCO’s quality pool dollars means meeting all
“must pass” measures identified by the MSC plus meeting 75% of the remaining measures,
“program change” means striking any measure in which a CCO has a denominator of zero from
calculations of whether a CCO earns 100% of its quality pool dollars.
On the topic of small denominators, MSC discussion included the distinction between a low
denominator and a denominator of zero, the relative impact of the different options on CCOs,
and whether measures adequately reflect CCO enrollees as a whole. Summer Prantl moved to
accept OHA Recommendation A (only allow a program change as defined above in instances
when a CCO has a true denominator of zero), Roshanthi Weerasinghe seconded. Aileen Duldulao
abstained; all others voted aye.
The Committee then discussed how to set an improvement target for the year following a CCO
having a denominator of zero for a measure. Discussion included TAG deliberation on the listed
options (see OHA recommendations document), the possibility of regional distinctions, and the
need for a simple and fair calculation method. Amit Shah moved to adopt OHA
Recommendation B (Set performance at median of all CCO performance for the year with zero
4Metrics & Scoring Committee
March 20, 2020
Location:
Webinar-based meeting
9:00 a.m. to 12:00 p.m.
denominator; use this as ‘baseline’ to calculate subsequent improvement target), Brian Sandoval
seconded. Aileen Duldulao abstained, all others voted aye.
For instances of significant membership change, OHA included a package of three related
recommendations, which could be adopted as a package:
• Recommendation 1: (a) keep the threshold for an automatic, single year adjustment to a
CCO’s improvement targets to a membership increase of 45% as set by MSC in July 2018
(b) continue to carry forward improvement target from previous year (also as set by MSC
in July 2018).
• Recommendation 2: (a) MSC direct OHA to work with the TAG to determine the
periodicity allowed for such change (e.g., only changes in first six months of year? etc.).
(b) MSC should decide if this rule needs to be sent to MSC for approval, or if it allows
OHA to create the rule.
• Recommendation 3: Allow CCOs to apply to MSC for a single year reassessment of their
improvement targets on a case-by-case basis for any reasons not covered above (e.g.,
membership decrease, overall change in member composition, etc.).
Dave Ross moved to adopt the package of recommendations; Brian Sandoval seconded. All
members voted aye. For Recommendation 2 specifically, Dave Ross moved to a dopt 2(a) (direct
OHA to work with the TAG to determine the periodicity allowed for such change, meaning MSC
does not need weigh in further on this issue), Summer Prantl seconded. All members voted aye.
Planning for Next Meeting 1:23:40
Sara discussed planning for the next two MSC meetings, including considering changes to the
measure criteria in light of the health equity definition and HPQMC’s new innovative measure
criteria. As time was limited, Amit asked members to send feedback via email.
Adjourn 1:27:05
Next meeting:
May 15, 2020 (April meeting cancelled)
Location: TBD
9:00 a.m. to 12:00 p.m.
5You can also read
