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2016 CCO Metrics Report

On June 30, 2017 the Oregon Health Authority released the CCO Metrics 2016 Final Report. This report details how each of the CCOs performs on a variety of quality metrics that measure different domains of care including access, patient experience, outcomes, and screening examinations.

The monies that fund the CCOs bonus are from a withholding of CCO funds that then have to be earned back by: Meet or exceed the benchmark or the improvement target, or the measurement and reporting requirements for the three clinical measures, on at least 75 percent of the incentive measures (13 of 17 measures); and Score at least 0.60 on the PCPCH enrollment measure using the tiered formula. There is also a challenge pool of funds ($27.4 million). Challenge pool funds are distributed to CCOs that meet the benchmark or improvement target on four measures.

In 2016 the challenge pool metrics were:
1. Alcohol and drug misuse screening (SBIRT)
2. Depression screening and follow-up plan
3. Developmental screenings
4. Diabetes Hemoglobin A1c poor control

As health system transformation continues to evolve and CCOs are expected to continue to improve, the benchmarks and improvement targets rise. In 2016, only 7 CCOs received 100% of their funds in the phase 1 distribution.

Evaluating the metrics there are a few notable thoughts:
--The metrics report only reports on the members enrolled in a CCO. The members who are on the fee-for-service population are not included in the report. In this report that accounts for approximately 18% of the total Medicaid population, however, with several new policies this number will be decreased as more members are assigned into CCOs.

--Race and ethnicity data is missing for a significant percentage of metrics and not reported on others. This is due to several reasons and will be improved, in many cases, with the implementation of the new ONE enrollment system. Also, the metrics that use the electronic health record (EHR) system for the data set is unable to link race and ethnicity data with the clinical data (i.e blood pressure and colorectal cancer screening)

--Diabetes, there are several metrics, one quality incentive metric evaluating diabetes poor control, and 2 additional ones that are state performance metrics evaluating hemoglobin A1c testing and cholesterol screening. Since the diabetes poor control metric requires EHR lab data, there is no continuous enrollment requirement so the number of members is considerable larger than the testing/screening metrics which does look at continuous enrollment.

--Hypertension, the recent JNC8 hypertension guidelines have increased the target blood pressure for people 60+ to 150/90. The current CCO quality incentive metrics evaluates the percentage of adults (18-85) <140/90. The report does not break down the two age populations, as it would be too challenging for clinics and CCOs since the data source is through EHR. In addition, national organizations are mostly using the total 18-85 population for measurement, but not all. This is one of many examples where the clinical standards change due to increased evidence, and the metrics technical specifications may lag behind due to different reasons.

The report documents the continued improvement of CCOs in meeting metrics. Many metrics have had their benchmarks raised and CCOs are working hard to further health system transformation and improve integration of systems.

The 2018 metrics will be finalized in the Metrics and Scoring meeting in July.

special thanks to OHA staff for answering technical questions

Posted on July 7, 2017.