1. 1 Mmmmm Making Meaningful Measures Charles Gallia, PhD State of Oregon, Health Authority, Division of Medical Assistance Programs

2. 2 How much do medical services contribute to health outcomes?

3. 3 An ‘Oregonized’ Care Model

4. 4 Tri-State Children's Health Improvement Consortium CHIPRA Quality Demonstration Grant –A partnership between Alaska, Oregon, and West Virginia Categories A, B, and C –Test the full range of measures, expand the adoption of medical homes, and use of EMRs- an integrated model

5. 5 The Initial Core Measures  Frequency of ongoing prenatal care  Otitis Media with Effusion - avoidance of inappropriate use of systemic antimicrobials  Timeliness of prenatal care  Total EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416 Line 12C)  % of live births weighing less than 2,500 grams  Emergency Department Utilization - Average number of emergency room visits per member per reporting period  Cesarean Rate for Low-risk First Birth Women  Pediatric catheter associated blood stream infection rates (ICU and high risk nursery patients)  Immunizations for 2 year-olds  Annual number of asthma patients (> 1 year-old) with > 1 asthma related ER visit  Adolescent immunization  Follow-up care for children prescribed attention- deficit/hyperactivity disorder (ADHD) medication  Body Mass Index (BMI) documentation 2 - 18 year olds  Child and adolescent Major Depressive Disorder  Rates of screening using standardized screening tools for potential delays in social and emotional development  Follow up after hospitalization for mental illness  Chlamydia screening 16-20 females  Annual hemoglobin A1C testing (all children and adolescents diagnosed with diabetes)  Well-child Visits 1) WCVs in the First 15 months of life; 2) WCVs in the third, fourth, fifth and sixth years of life; 3) Adolescent WCV  HEDIS CAHPS 4.0 including supplements for children with chronic conditions and Medicaid Plans  Total eligibles receiving preventive dental services  Annual dental visit  Pharyngitis - appropriate testing  Access to primary care practitioners, by age and total

6. 6 As an Assuring Better Child Health and Development (ABCD) III State Develop sustainable developmental screening and referral linkages Using External Quality Review Process Using Community Cafes Building on success

7. 7 Applying it

8. 8 Public Measures Refrain When we report measures the reaction is familiar Like the grieving process Critique : Not based on SMART goals Specific Measurable Attainable Relevant Timely

9. 9 Applying it

10. 10 Applying it continued The national average was 19.5% Based on current record enrollment, if Oregon was to be average- as a goal that equals 25,000 screenings (not taking in account real adjustment). Last year there was 12,000

11. 11 Does this measure have meaning? To clinicians To parents To managed care organization To policy makers

12. 12 Harmonizing Different Views  Federal  State  Providers  Consumers- Citizens Different Needs  Value?  Effective?  Appropriat e?  Safe?  Highest quality

13. 13 Definitions Measurement Financing Expertise Shared Resources Training Redesign Quality Improvement STATE Policy Framework COMMUNITY Care Coordination PRIMARY CARE PRACTICE Systematic Approach to Improving Health System Performance

14. 14 Measures vary By the audience By method By message By meaning Macro and micro measures

15. 15 Solutions Understand – There are Macro and Micro health care measures, of equal importance – Measures vary in value and meaning Engage stakeholders Find areas of mutual achievement Pool resources Inspire Innovation

16. 16 Contact Information Charles Gallia, PhD State of Oregon Division of Medical Assistance Programs Charles.a.gallia@state.or.us 503-945-6929