Members of the Oregon Health Policy Board are asking the Office of Health Analytics to put race and other indicators of equity gaps in regular reports on coordinated care organization performance. The board is also urging health authority leaders to consider policy changes where the state is lagging; no CCO met the state’s top benchmark for childhood immunization, for example.
Health authority staff, meanwhile, are looking for guidance on the priorities that should guide their data gathering and analysis. What data points can be used to measure efforts to address social determinants of health, for example?
And as these initiatives roll forward, a big-money data-driven effort to improve the quality of care at hospitals is nearing its end. The hospital transformation performance program, approved in 2013 with funding from a provider tax on the state’s largest hospitals, was not continued in this Legislative session.
The program assessed eleven distinct health outcomes, and distributed quality payments to hospitals based on whether they met minimum improvement targets, with larger payments to hospitals that meet more challenging benchmarks.
In the first three years of the hospital transformation program, hospitals received $387.5 mllion in quality pool funds through the transformation project, with third-year performance payments going out in June.
“Year four will be the last year,” said Jon C. Collins, PhD, director of health analytics for the Oregon Health Authority. “One of the things the Health Plan Quality Metrics Committee si goingto have to take under consideration is how they intend to continue to build on this.”
Collins particularly praised Legacy Mount Hood, as the first hospital to achieve at least an improvement target, if not a benchmark goal, in each of the eleven measures tracked. “That’s the first time that has happened,” he said.
Over the first three years of the program, here is how participating hospitals have fared, ranked from highest incentive payment to lowest:
- OHSU Hospital had 8,024 Medicaid discharges, achieved 8 performance measures, and has received $12,771,063 in incentive payments.
- Providence St. Vincent had 4,326 Medicaid discharges, achieved 10 performance measures, and has received $9,140,046 in incentive payments.
- Legacy Emanuel had 5,641 Medicaid discharges, achieved 7 performance measures, and has received $8,302,932 in incentive payments.
- Providence Portland had 4,875 Medicaid discharges, achieved 8 performance measures, and has received $7,850,798 in incentive payments.
- Asante RogueRegional had 2,548 Medicaid discharges, achieved 9 performance measures, and has received $4,749,047 in incentive payments.
- PeaceHealth Sacred Heart - RiverBend had 5,395 Medicaid discharges, achieved 7 performance measures, and has received $4,737,389 in incentive payments.
- Salem Health had 3,817 Medicaid discharges, achieved 8 performance measures, and has received $3,713,448 in incentive payments.
- Legacy Mount Hood had 1,584 Medicaid discharges, achieved 11 performance measures, and has received $3,416,424 in incentive payments.
- Legacy Good Samaritan had 1,385 Medicaid discharges, achieved 9 performance measures, and has received $3,347,854 in incentive payments.
- Adventist had 2,959 Medicaid discharges, achieved 7 performance measures, and has received $2,792,616 in incentive payments.
- St. Charles Bend had 2,679 Medicaid discharges, achieved 7 performance measures, and has received $2,470,299 in incentive payments.
- Providence Willamette Falls had 1,087 Medicaid discharges, achieved 10 performance measures, and has received $2,106,468 in incentive payments.
- Sky Lakes had 1,332 Medicaid discharges, achieved 9 performance measures, and has received $2,058,266 in incentive payments.
- Mercy had 1,738 Medicaid discharges, achieved 8 performance measures, and has received $2,005,539 in incentive payments.
- Willamette Valley had 848 Medicaid discharges, achieved 10 performance measures, and has received $1,991,275 in incentive payments.
- Asante Three Rivers had 1,743 Medicaid discharges, achieved 8 performance measures, and has received $1,971,345 in incentive payments.
- PeaceHealth Sacred Heart - University had 531 Medicaid discharges, achieved 9 performance measures, and has received $1,886,200 in incentive payments.
- Samaritan Albany General Hospital had 1,020 Medicaid discharges, achieved 9 performance measures, and has received $1,828,723 in incentive payments.
- Providence Medford had 1,203 Medicaid discharges, achieved 8 performance measures, and has received $1,725,312 in incentive payments.
- Providence Milwaukie had 828 Medicaid discharges, achieved 9 performance measures, and has received $1,549,890 in incentive payments.
- Tuality Healthcare had 1,269 Medicaid discharges, achieved 7 performance measures, and has received $1,269,776 in incentive payments.
- Legacy Meridian Park had 611 Medicaid discharges, achieved 9 performance measures, and has received $1,208,580 in incentive payments.
- McKenzie-Willamette had 1,152 Medicaid discharges, achieved 5 performance measures, and has received $1,207,499 in incentive payments.
- Bay Area Hospital had 1,235 Medicaid discharges, achieved 6 performance measures, and has received $822,183 in incentive payments.
- Shriners Hospital for Children had 203 Medicaid discharges, achieved 7 performance measures, and has received $800,535 in incentive payments.
- Kaiser Sunnyside had 625 Medicaid discharges, achieved 8 performance measures, and has received $605,447 in incentive payments.
- Good Samaritan Regional had 1,368 Medicaid discharges, achieved 4 performance measures, and has received $598,508 in incentive payments.
- Kaiser Westside had 30 Medicaid discharges, achieved 10 performance measures, and has received $554,903 in incentive payments.
While the hospital performance program will retire after payments are made in June 2018, a similar program that seeks to nudge CCOs toward better results through data will continue.
CCOs can earn quality incentive payments by reaching minimum improvement targets or higher benchmarks on at least 13 of 18 measures, if 60 percent or more of their members are enrolled in patient-centered primary care homes.
In 2016, $179 million was available in quality payments. While all 16 of the state’s CCOs showed improvements last year, only seven earned the full quality payment they were eligible for: AllCare, PacificSource - Central Oregon, Primary Health of Josephine County, Umpqua Health Alliance, Western Oregon Advanced Health, Willamette valley Community Health and Yamhill Community Care.
Here’s how funds were distributed to CCOs in 2016, ranked from largest distribution to smallest:
- Health Share of Oregon met 11.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $40,976,948.
- Willamette Valley Community Health met 14 of 18 measures, and also achieved 4 challenge measures. It received total payment of $22,302,539.
- FamilyCare met 11.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $19,481,835.
- Trillium met 12.8 of 18 measures, and also achieved 3 challenge measures. It received total payment of $17,217,360.
- PacificSource – Central Oregon met 13.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $11,915,802.
- Intercommunity Health Network met 11.8 of 18 measures, and also achieved 3 challenge measures. It received total payment of $10,585,279.
- AllCare Health Plan met 14.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $10,521,689.
- Eastern Oregon CCO met 12.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $10,081,371.
- Umpqua Health Alliance met 14 of 18 measures, and also achieved 4 challenge measures. It received total payment of $6,299,066.
- Jackson Care Connect met 11.8 of 18 measures, and also achieved 4 challenge measures. It received total payment of $5,612,931.
- Columbia Pacific met 12.9 of 18 measures, and also achieved 4 challenge measures. It received total payment of $5,546,730.
- Western Oregon Advanced Health met 14.9 of 18 measures, and also achieved 4 challenge measures. It received total payment of $5,466,380.
- Yamhill Community Care met 13.9 of 18 measures, and also achieved 3 challenge measures. It received total payment of $5,195,924.
- Cascade Health Alliance met 10.8 of 18 measures, and also achieved 3 challenge measures. It received total payment of $2,808,729.
- PrimaryHealth of Josephine County met 16 of 18 measures, and also achieved 4 challenge measures. It received total payment of $2,629,671.
- PacificSource – Gorge met 11 of 18 measures, and also achieved 3 challenge measures. It received total payment of $2,196,970.
Reviewing performance data, Oregon Health Policy Board member Felisa Hagins, political director for Service Employees International Union Local 49, raised concerns about areas where all the state’s CCOs seem to lag. For example, none achieved the highest benchmark standard for childhood immunizations last year.
“I mean, we have a whooping cough outbreak,” Hagins said. “Why are we not immunizing our kids? This is science. We should immunize our children. CCOs should encourage peopleto immunize their children. It’s a public health crisis.”
Collins noted that the state could theoretically be doing well yet still show no CCOs meeting benchmarks because of nuances in the data. For example, if a child misses one shot but gets all other immunizations, that does not count toward the benchmark.
Nonetheless, he concurred that significant room exists for improvement – and Lynne Saxton, director of the Oregon Health Authority, said that the data is key to making those improvements.
“That’s a very critical component of changing the culture and changing performance,” Saxton said.
Hagen also criticized the most recent hospital and CCO reports prepared by the Oregon Health Authority for omitting issues of equity, such as how well Medicaid-funded programs serve people of color, people with disabilities, and other groups.
“Medicare has a requirement on equitable treatment of people. Medicaid has a requirement for equitable treatment of people. We have been talking about this for two decades. I don’t want us to lose sight of this,” she said, expressing frustrating at the absence of data in recent performance reports.
“That’s a weakness we have right now,” Collins said. ”We have a lot of this data, but we do not have individuals pouring over it and doing the analysis we need”
Hearing the shortcoming, Saxton said she would direct the health authority’s Office of Equity and Inclusion to take on that analysis.
The Oregon Health Authority is also preparing to expand its data tracking and analysis in an effort to improve performance of Oregon Educators Benefits Board and Public Employees Benefits Board health plans.
“Right now, the metrics and scoring committee is making decisions on what we are going to incentivize for calendar contract year 2018 for the CCOs,” with those recommendations likely to also apply in tracking of PEBB and OEBB plans, Collins said – nothing that applying incentives to PEBB and OEBB will have a significant impact.
“We have driven a lot of the transformation that we’ve seen through these incentives that we’ve rewarded for particular measures,” he said. “If we really want to push the system, we have to be careful about the measures that we pick, and be willing to take some chances.”
Reach Courtney Sherwood at [email protected].
