Oregon’s Hospital Transformation Performance Program

(HTPP)October 2013 – December 2017

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HTPP Overview• Incentive measure program for 28 DRG hospitals in Oregon• Approved through OHA’s 1115 Medicaid waiver

• 2013 – Established program by HB2216 • 2015 – Approved for an additional 4 years by HB2395 • 2017 - Not included in budget for 2017-2019 biennium during

the regular legislative session

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Oregon DRG Hospitals (28)• Adventist Medical Center, Portland • Asante Rogue Medical Center, Medford • Asante Three Rivers, Grants Pass • Bay Area Hospital, Coos Bay • Good Samaritan Regional, Corvallis • Kaiser Sunnyside, Clackamas • Kaiser Westside, Hillsboro • Legacy Emanuel, Portland • Legacy Good Samaritan, Portland • Legacy Meridian Park, Tualatin • Legacy Mount Hood, Gresham • McKenzie-Willamette, Springfield • Mercy Medical Center, Roseburg • OHSU Hospital, Portland • PeaceHealth RiverBend, Springfield • PeaceHealth University District, Eugene

• Providence Medford, Medford • Providence Milwaukie Hospital,

Milwaukie • Providence Portland, Portland • Providence St. Vincent, Portland • Providence Willamette Falls, Oregon City • Salem Health, Salem • Samaritan Albany General Hospital,

Albany • Shriners Hospital for Children, Portland • Sky Lakes Medical Center, Klamath Falls • St. Charles Bend Medical Center, Bend • Tuality Healthcare, Hillsboro• Willamette Valley Medical Center,

McMinnville

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HTTP Program YearsBaseline year: hospitals received payment for reporting baseline data• Year 1 – October 1, 2013 to September 30, 2014

Years 2-4: hospitals received payment for meeting improvement targets or benchmarks on each of the quality metrics • Year 2 – October 1, 2014 to September 30, 2015 • Year 3 – October 1, 2015 to September 30, 2016 • Year 4 – January 1, 2017 to December 31, 2017

(updated to align with CCO measurement period)

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HTPP Focus Areas, Domains and MeasuresFocus Area Domains Measures

Hospital Focus

1. Readmissions 1. Hospital –wide All-cause Readmissions

2. Medication Safety2. Hypoglycemia in inpatients receiving insulin3. Excessive anticoagulation with Warfarin4. Adverse Drug Events due to Opioids

3. Patient Experience5. HCAHPS, Staff always explained medicines6. HCAHPS, Staff gave patient discharge information

4. Healthcare-AssociatedInfections

7. CLABSI in all tracked units8. CAUTI in all tracked units

Hospital- CCO collaboration

focus

5. Sharing ED visit information

9. Hospitals share ED visit information with primary care providers and other hospitals to reduce unnecessary visits

6. Behavioral Health

10. Follow-up after hospitalization for mental illness11. Screening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) in the Emergency Department

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HTPP Measure Data SourcesData Source Measures

By Office of Health Analytics (2)Hospital –wide All-cause ReadmissionsFollow-up after hospitalization for mental illness

Self-reported to OAHHS through the Apprise Reporting Platform (6)

Hypoglycemia in inpatients receiving insulinExcessive anticoagulation with WarfarinAdverse Drug Events due to OpioidsScreening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) in the Emergency DepartmentHCAHPS, Staff always explained medicinesHCAHPS, Staff gave patient discharge information

By Public Health Division, Healthcare-Associated Infections through NHSN (2)

CLABSI in all tracked unitsCAUTI in all tracked units

By CMT through the EDIE reporting platform (1)

Hospitals share ED visit information with primary care providers and other hospitals to reduce unnecessary visits

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Funding• Funding is provided by the Hospital Provider Assessment

Program. Only hospitals that pay this assessment are included in the HTPP.

• Years 1 & 2: Equal to 1% of federal financial participation (capped at $150 million per year)

• Years 3 & 4: Equal to 0.5% of federal financial participation

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Incentive Payment Structure• Part 1 – Floor Payment Hospitals are eligible to receive $500,000 “floor” payment if they meet the performance goal for at least 75% of the measures for which they are eligible.• Part 2 – Quality Pool Payment The remaining funds are distributed based upon the number of measures for which they meet the performance goals.

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Measure Measure Weight

Adverse drug event due to opioids 6.25%Excessive anticoagulation with warfarin 6.25%Hypoglycemia in inpatients receiving insulin 6.25%SBIRT Screening in the ED 6.25%Follow-up after hospitalization for mental illness 6.25%CAUTI in all tracked units 9.38%CLABSI in all tracked units 9.38%HCAHPS: Staff always explained medicines 9.38%HCAHPS: Staff gave patient discharge information 9.38%EDIE: Hospitals share ED visit info 12.50%Hospital-wide all-cause readmissions 18.75%Total 100.00%

1) Measure $ Value = (# hospitals meeting measure) X (measure weight x part 2 incentive pool)2) Hospital $ per measure = based on hospital size (50% of hospital Medicaid discharges & days)

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Quality Pool Distribution: Year 4 (2017)

Part 1: Floor payment = $4,000,000• 8 hospitals received the floor payment, each hospital met the performance targets for at least 75% of the measures

Part 2: Quality Pool = $85,758,990•The remaining funds are allocated to hospitals based on their performance on the individual measures (weighted distribution in previous slide)

Total funds distributed in program year 4 = $89,758,990

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For more information on funding for the HTPP:• Oregon’s 1115 Medicaid Demonstration Waiver (to CMS):

Attachment J, Hospital Metrics and Incentive Payment Protocol (page 365-381)

• Oregon’s Health Plan Financing and Medicaid Provider Taxes https://olis.leg.state.or.us/liz/2017R1/Downloads/CommitteeMeetingDocument/100071

• Oregon Legislative 2017 Session: House Bill 2391 https://olis.leg.state.or.us/liz/2017R1/Downloads/MeasureDocument/HB2391/Enrolled

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Metrics Quick Reference Materials

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Contrast & Compare: CCO and HTPP Programs

CCO Incentive Program Hospital Incentive Program

CCOs are paid a global budget and are also eligible for BONUS “quality pool” money.CCO’s can earn 100% of their quality pool if they achieve 75% of the measures.

Hospitals are paid a floor payment for meeting 75% of measures and get paid for each measure met based on a weighted formula.

Metrics selected by the Metrics and Scoring Committee. There are 17 measures this year.

Metrics selected by the HTPP Advisory Committee. There are 11 measures this year.

Data sources – predominately claims and EHR Data sources – predominately claims and self-reported. CMT and HAI use 2 other reporting platforms

15 CCO’s cover the entire state 28 hospitals mostly in urban settings

Approved through OHA’s 1115 Medicaid waiver

Approved through OHA’s 1115 Medicaid waiver

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HTPP and CCO Shared Quality MeasuresHTPP Measures CCO Measures

Sharing ED Visit Information

Reduce ED visits for high utilizers ED utilization for the general population

ED utilization of CCO members with mental illness.

Behavioral Health

Follow-up after hospitalization for mental illness

Follow-up after hospitalization for mental illness

Screening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) in the Emergency Department

Screening for alcohol and drug misuse, brief intervention, and referral to treatment (SBIRT) annually in the primary care setting

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HPQMCDevelops Annual

Measure Set

Metrics & ScoringResearches New Measures

Determines Annual CCO Measure Sets &

Benchmarks

Health Policy Board

Technical Advisory Group

Metrics and Health System Transformation:Setting the Stage

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