Quality Council
Review the agenda for the upcoming Quality Council meeting on September 19, 2024. Topics include call to order, approval of meeting minutes, bylaws revisions, annual benchmark review, meeting plan, public comment, and adjournment. The meeting will also address changes in council membership, terms, and responsibilities. Explore the proposed bylaws amendments and their implications for council governance. Stay informed on quality benchmarks and their impact on healthcare initiatives.
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Presentation Transcript
Quality Council September 19, 2024
Agenda Time 3:00 p.m. Call to Order, Roll Call, and Agenda Review 3:05 p.m. Approval of June 20, 2024 Meeting Minutes Vote 3:10 p.m. Quality Council Bylaws 3:25 p.m. Quality Council Chair(s) 3:40 p.m. Annual Review of Quality Benchmark Specification Changes 4:10 p.m. 2024-2025 Quality Council Meeting Plan 4:20 p.m. Public Comment 4:25 p.m. Meeting Wrap-Up and Next Steps 4:30 p.m. Adjournment Topic
Approval of June 20, 2024 Meeting Minutes - Vote
Quality Council Bylaws Prior to today's meeting, OHS distributed for review a revised bylaws document along with a second document summarizing the proposed changes. The changes include: oClarifications to the goals, objectives, and duties of the Council oClarifications to the Council categories of membership oReduction in the potential size of the Council from 20-27 to 13-25 members oMoving to two-year terms without a maximum time served oShifting the obligation from the Council / Chair(s) to OHS for Discharging members for cause Appointing members to fill vacancies Appointing Chair(s) Vote: Do members approve of the revised bylaws? Quality Council Bylaws
Annual Review of Quality Benchmark Specification Changes
Quality Benchmarks As a reminder... In 2020, Governor Lamont signed Executive Order No. 5 directing OHS to develop annual Quality Benchmarks for CY 2022-2025. In 2022, C.G.S. 19a-754f et seq codified the Executive Order and created Quality Benchmark reporting requirements. In 2021, OHS selected seven Quality Benchmark measures and Benchmark values for phased implementation, per the Quality Council s recommendation. Since that time, we have annually reviewed changes to the Quality Benchmark measure specifications. Quality Benchmarks
Quality Benchmark Measures Phase 1: Beginning for 2022 Phase 2: Beginning for 2024 Asthma Medication Ratio Controlling High Blood Pressure Hemoglobin A1c (HbA1c) Control for Patients with Diabetes: HbA1c Poor Control Child and Adolescent Well- Care Visits Follow-up After Hospitalization for Mental Illness (7-day) Follow-up After ED Visit for Mental Illness (7-day) Obesity Equity Measure Quality Benchmark Measures
Process for Reviewing Changes to Quality Benchmark Measure Specifications (1 of 2) Step 1: OHS reviews measure specification changes for major specification changes. oFor NCQA measures: OHS will review the measure specification changes that are released by NCQA by August 1st preceding the measurement year (MY) (e.g., specifications released in by August 1, 2024 for MY 2025). oFor the Obesity Equity Measure: OHS will review the Behavioral Risk Factor Surveillance System (BRFSS) survey questions, method of distribution, the population receiving the survey, and any other change that might affect comparability. Process for Reviewing Changes to Quality Benchmark Measure Specifications
Process for Reviewing Changes to Quality Benchmark Measure Specifications (2 of 2) Step 2: If OHS considers the measure specification changes to be substantive, OHS solicits Quality Council input on how to respond. Options include: 1. Removing the Quality Benchmark measure for the upcoming measurement year and considering inclusion of an alternate measure. 2. Resetting the Quality Benchmark value for the upcoming measurement year using the same methodology used to develop the initial values. 3. Maintaining the Quality Benchmark measure without reporting performance against a benchmark. Process for Reviewing Changes to Quality Benchmark Measure Specifications
Timeline for Reviewing Changes to Quality Benchmark Measure Specifications August: OHS reviews measure specifications to identify if there have been substantive changes. September (today!): OHS solicits feedback from the Quality Council on potential actions. October: OHS makes a final decision on how to address substantive changes. Timeline for Reviewing Changes to Quality Benchmark Measure Specifications
2025 Measure Specification Changes NCQA Measures: NCQA released its final 2025 HEDIS measure specifications in July. NCQA made significant changes to two Quality Benchmark measures: oFollow-Up After Emergency Department Visit for Mental Illness oFollow-Up After Hospitalization for Mental Illness Obesity Equity Measure: There were no changes to the relevant height and weight questions in the 2024 CT Behavioral Risk Factor Surveillance System (BRFSS) survey. 2025 Measure Specification Changes
Follow-Up After Emergency Department Visit for Mental Illness: 2025 Specification Changes (1 of 2) 1. Updated denominator criteria to include phobia diagnoses, anxiety diagnoses, intentional self-harm X- chapter codes and the R45.851 suicidal ideation code. 2. Expanded the numerator criteria with additional follow- up options, including expansion of provider-type options and inclusion of psychiatric residential treatment and peer support services for mental health. Follow-Up After Emergency Department Visit for Mental Illness: 2025 Specification Changes
Follow-Up After Emergency Department Visit for Mental Illness: 2025 Specification Changes (2 of 2) 3. Modified the denominator criteria to allow intentional self-harm diagnoses to take any position on the claim. 4. Modified the numerator criteria to allow a mental health diagnosis to take any position on the claim and removed visits requiring both a mental health diagnosis and self-harm diagnosis from the numerator. Follow-Up After Emergency Department Visit for Mental Illness: 2025 Specification Changes
Follow-Up After Hospitalization for Mental Illness: 2025 Specification Changes 1. Updated denominator criteria to include phobia diagnoses, anxiety diagnoses, intentional self-harm X- chapter codes and the R45.851 suicidal ideation code. 2. Expanded the numerator criteria with additional follow- up options, including expansion of provider-type options and inclusion of psychiatric residential treatment and peer support services for mental health. Follow-Up After Hospitalization for Mental Illness: 2025 Specification Changes
NCQAs Mental Health Follow-Up Measures: Impact of Specification Changes NCQA expects the specification changes for both mental health follow-up measures to positively impact performance. This means that it should be easier for payers and Advanced Networks to achieve the 2025 benchmarks for these measures. NCQA s Mental Health Follow-Up Measures: Impact of Specification Changes
NCQAs Mental Health Follow-Up Measures: 2025 Quality Benchmark Options For the 2025 Quality Benchmarks, should OHS remove the two mental health follow-up measures, reset the benchmark values, or maintain the measures and values? OHS recommends taking the same approach as it did last year after NCQA made major changes to the specifications for Glycemic Status Assessment for Patients with Diabetes (>9.0%): maintain the measures as Quality Benchmarks without reporting performance against benchmark values. Do members agree with OHS recommended approach? NCQA s Mental Health Follow-Up Measures: 2025 Quality Benchmark Options
2024-2025 Quality Council Meeting Plan
2024-2025 Quality Council Meeting Plan Meeting Primary Agenda October 2024 Begin abbreviated Aligned Measure Set annual review November 2024 Continue annual review, including discussion of Health Equity Subgroup recommendations Finish annual review, check in on 2024 goals and develop 2025 goals December 2024 January 2025 Begin discussion of 2026-2030 Quality Benchmarks and finalize 2025 goals Continue discussion of 2026-2030 Quality Benchmarks February 2025 March 2025 Continue/Finish discussion of 2026-2030 Quality Benchmarks April 2025 Finish discussion of 2026-2030 Quality Benchmarks, if necessary 2024-2025 Quality Council Meeting Plan
Meeting Wrap-Up and Next Steps The Quality Council will meet next on Thursday, October 17th from 3-5 pm. Begin abbreviated annual review for the 2026 Aligned Measure Set 10/17
NCQA Quality Benchmark Measures: Summary of Minor Specification Changes for 2025 Measure Name Summary of Changes Asthma Medication Ratio Added albuterol-budesonide as an asthma reliever medication. Clarified that RxNorm codes should not be used when identifying required exclusions. Removed the data source reporting requirement for race/ethnicity stratification. Removed telehealth well visits (which were temporarily added during the COVID-19 pandemic) from the numerator. No changes No changes Child and Adolescent Well-Care Visits Controlling High Blood Pressure Glycemic Status Assessment for Patients with Diabetes (>9.0%) NCQA Quality Benchmark Measures: Summary of Minor Specification Changes for 2025
