Oregon Health Authority 2021 CCO Quality Incentive Program Benchmark Reopening Protocol - Oregon.gov
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Oregon Health Authority
2021 CCO Quality Incentive Program Benchmark
Reopening Protocol
____________________________________________________________________________________
Background
At its October 2020 meeting, the Metrics and Scoring Committee (M&SC) finalized benchmarks
for the 2021 incentive program. Given the COVID-19 pandemic, M&SC made the following
decisions regarding the 2021 benchmarks:
• Use 2019 as a baseline for assessing quality improvement in 2021 (as 2020 is
inappropriate to use in assessing quality improvement);
• Rather than increasing benchmarks, roll forward the original 2020 benchmarks into
2021; and,
• Drop floors for improvement targets, making it easier to attain targets.
M&SC also chose to formally note that the benchmarks for individual measures may be
reassessed if predetermined criteria related to extenuating external factors are met. High-level
benchmark reopening criteria from M&SC are:
1. School opening (e.g., X% of schools statewide still in Comprehensive Distance Learning)
2. County reopening phases (e.g., X% of counties move back to baseline)
3. Governor’s state of emergency (e.g., extended dates)
4. Suspension of elective procedures and preventive visits (e.g., tied to Governor’s
executive orders)
5. COVID cases per 100,000 people part of phased reopening (e.g., based upon reopening
criteria for different phases)
6. Rescission or reduction of Oregon Health Plan expansion of telemedicine coverage, no
longer aligning with specifications for some measures.
For measures meeting the criteria, M&SC will decide if the benchmark should be revisited, and
if so, the degree to which reductions might be made. This will be done on an individual measure
basis, using indicators tied to each criterion. The Oregon Health Authority (OHA) will not make
changes to how it calculates individual measures – the only potential changes are revisions to
benchmarks for the impacted measures meeting the indicators.
Timeline
The Committee tasked OHA with operationalizing the above criteria as below:
• June 2021. OHA will finalize a benchmark reopening protocol (this document), which
operationalizes the high-level criteria agreed upon by the Committee. This includes
2021 Benchmark Reopening Protocol Page 1 of 7
Correction issued July 17, 2021looking at which factors are linked with individual measures.
• November 2021. On an ongoing basis, OHA is monitoring events to track whether any
reopening criteria have been met. If any of the criteria are met for a specific measure
and could negatively impact any individual measures as outlined in this document,
M&SC will consider revising 2021 benchmarks for these individual measures no later
than its November 2021 meeting.
Operationalizing the Criteria
In operationalizing the criteria, OHA staff reviewed all relevant executive orders and consulted
with internal and external subject matter experts for each measure and criterion, including
teams within OHA’s Public Health Division and the Oregon Department of Education. OHA also
consulted with the CCO metrics Technical Advisory Group (TAG), including a survey of CCOs and
discussions at multiple meetings from February – May 2021.
This information was used to:
• Map individual measures to criteria (i.e., which measures might see a negative impact
on performance outside the control of CCOs, due to each criterion).
• Combine criteria where appropriate (e.g., county reopening phases linked with case
rates)
• Create indicators for each criterion.
The matrix on page 4 shows indicators for each criterion as well as how individual measures are
mapped across the criteria. Of note:
• M&SC initially included a sixth criterion related to the Governor's State of Emergency.
Upon examination of the Executive Order, however, it became clear that this criterion,
in and of itself, does not link to performance. This Executive Order is administrative in
terms of managing the emergency (i.e., allows for other rules, etc., related to
pandemic). Essentially, it allows for the changes in the other criterion, but does not in
and of itself map to performance. Therefore, it is not included separately.
• Medical and dental facilities were never required to close; hence criterion 4 has been
renamed.
• County reopening phases and COVID cases per 100,000 have been combined due to
overlap in policy and link between county reopening phases and case rates.
• As a practical matter, the telehealth indicator is unlikely to take effect. This criterion is
included in the matrix because it was part of the original proposal. Expanded telehealth
coverage is now codified in administrative rules, however, making it unlikely that this
indicator for reopening benchmarks would apply.
2021 Benchmark Reopening Protocol Page 2 of 7
Correction issued July 17, 2021• Each column of the table is a criterion and each row is a measure.
o For example, four measures are mapped with the school reopening criterion as
distance learning could have a negative impact on performance outside CCO
control.
2021 Benchmark Reopening Protocol Page 3 of 7
Correction issued July 17, 20211
Criteria for Revisiting Benchmarks
County reop ening p hases (e.g., X% of counties move Oregon Health Plan exp ansion of
Susp ension of elective p roced ures
back to baseline) COMBINED with COVID cases p er telemed icine coverage is rescind ed or
School op ening^ and p reventive visits (e.g., tied to
100,000 p eop le p art of p hased reop ening (e.g., 3
red uced , no longer aligning with
2 Governor's executive orders) 6
based upon reopening criteria for different phases)^ specifications for some measures
% students in on-site learning (per ODE, on-
site attendance any day per week,
including multiple instructional models,
such as on-site full-time or hybrid). Local
indicator
Note: Calculation is based on average Y/N on mandated suspension statewide
weekly attendance from Jan. 2021 - week Counties at extreme or high risk level for 10 weeks of the Y/N if telehealth coverage is rescinded at
Indicator at any point in the first three quarters of
of May 23, 2021. first three quarters of 2021. Local indicator any point in the first three quarters of 2021.
2021.
4
*numerator source = ODE weekly report
*denominator source = ODE student
5
membership report, published Feb. 2021
*threshold N/A (as four measures below
met within County reopoening/COVID case
rate criteria)
Potential number of measures impacted 4 8 8 7
1. Childhood immunization status - Combo 2 X X X
2. Immunizations for adolescents - Combo 2 X X X
3. Well-child visits in the 3rd, 4th, 5th, and 6th years of life X X X X
4. Prenatal and postpartum care - Postpartum care X X X
5. Cigarette smoking prevalence
6. Members receiving preventive dental services, ages 1-5
X X X X
(kindergarten readiness) and 6 - 14
7. Oral evaluation for adults with diabetes X X X
8. Mental, physical, and oral health assessments within 60
X X
days for children in DHS custody
9. Comprehensive diabetes care: HbA1c poor control X X
10. Initiation and engagement of alcohol and other drug
X X
abuse or dependence treatment
11. Disparity measure: Emergency department utilization
among members with mental illness
12. Equity measure: Meaningful language access to
X
culturally responsive health care services
13. Screening, brief intervention, and referral to treatment N/A - already reporting only for 2021
14. Depression screening and follow-up N/A - already reporting only for 2021
Notes
^Light blue text denotes criterion with local indicators. For these two criteria, only the CCOs operating in areas meeting the indicator threshold will receive any ‘new’ benchmark from the Metrics & Scoring
Committee; all other CCOs will be held to original benchmarks from Metrics & Scoring Committee.
*Purple denotes 2021 Challenge Pool measures
1
The Metrics & Scoring Committee initially included a sixth criterion related to the Governor's State of Emergency. Upon examination of the Executive Order, however, it became clear that this criterion, in and of
itself, does not link to performance. This Executive Order is administrative in terms of managing the emergency (i.e., allows for other rules, etc, related to pandemic). Essentially, it allows for the changes in the other
criterion, but does not in and of itself map to performance. Therefore, it is not included here separately - but within the other criterion.
2
County reopening phases and COVID cases per 100,000 have been combined due to overlap in policy, and link between county reopening phases and case rates.
3
Medical and dental facilities were never required to close; hence this criterion has been renamed.
4
See https://www.oregon.gov/ode/students-and-family/healthsafety/Pages/2020-21-School-Status.aspx
5
See https://www.oregon.gov/ode/reports-and-data/students/Pages/Student-Enrollment-Reports.aspx.
6
As a practical matter, the telehealth indicator is unlikely to take effect. This criterion is included in the matrix because it was part of the original proposal. Expanded telehealth coverage is now codified in
administrative rules, however, making it unlikely that this indicator for reopening benchmarks would apply.
2021 Benchmark Reopening Protocol
Correction issued July 17, 2021
Page 4 of 7Statewide and Local Indicators
Two of the four final criteria on the matrix will utilize statewide indicators (suspension of elective procedures and telehealth coverage expansion).
This means that if the indicator is met at the statewide level, M&SC will consider reductions to the benchmarks for the measures which are
mapped to these indicators for all CCOs. This is illustrated below.
Page 5 of 7In response to CCO feedback, two of the four final criteria on the matrix will utilize local indicators. This means that if the indicator is met for any
individual CCOs, M&SC will consider reductions to the benchmarks for the measures which are mapped to these indicators for those CCOs only.
This is illustrated below.
Page 6 of 7Next Steps
As of this writing, all CCOs have met the indicator for the county reopening/case rates criterion. This means that M&SC will review the benchmarks
for the eight nine measures mapped to this criterion. At the discretion of M&SC, some or all of these benchmarks may be reduced. Whether and
the degree to which benchmarks might be reduced (e.g., from 90th percentile to 75th, etc.) is at the sole discretion of M&SC. M&SC will make these
decisions no later than its November 2021 meeting.
As the four measures mapped to school reopening are also mapped to county reopening, this criterion is effectively moot, since M&SC will already
review the benchmarks for these measures based on the county reopening/case rates criterion.
OHA will monitor the other criteria through September 2021. Should the indicator be met for suspension of elective procedures and/or
telemedicine coverage, M&SC would consider revisions to benchmarks for any measures not already mapped to the county reopening/case rates
criterion no later than its November 2021 meeting. Per the matrix, this is for the following measures:
• Assessments for children in DHS custody
• Equity measure: Meaningful language access to culturally responsive health care services
Questions?
Contact the Quality Metrics, Surveys, & Evaluation (QMSE) team at Metrics.Questions@dhsoha.state.or.us
Version Control
19 July 2021. This document was updated on 19 July 2021 to correct an error on the matrix and in the Next Steps section to note that the County
Reopening / Case Rates criterion is mapped to eight, not nine, measures. The matrix itself remains unchanged other than correcting the count of
measures mapped to the criterion.
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