Below is the HillCo client report from the December 17 Institute for Health Care Quality & Efficiency Board of Directors work group meeting.

The work group met to hear presentations from HHSC staff regarding data collection and quality metrics.
 
Matthew Ferrara, Director of Health Policy and Clinical Services, HHSC

  • Current drivers within the HHSC enterprise include a shrinking fee for service population and a growing MCO population as well as new programs, populations and services stemming from SB 7 and SB 58
  • Levers currently being used to increase quality:
    • MCO/DMO capitation risk
      • A percentage of capitation is placed at risk based on performance on targeted measures
    • Fee for service hospital reimbursement adjustments and MCO capitation adjustments based on potentially preventable readmissions and complications
    • MCO report cards
      • To be implemented in early 2014
    • MCO/DMO contractual requirements
    • Quality based enrollment incentives
      • Currently exploring this idea
    • Profits rebated to the state
      • Currently exploring this idea
    • Quality website
      • To be implemented in early 2014
      • Will include DSRIP projects
  • Overall challenges to all levers include selecting quality measures and finding and using the best data
  • Currently exploring alternative capitation methodologies, discussing methods used in 12 other states
  • There are numerous initiatives focused on quality and efficiency within the HHSC enterprise most of which are derived from claims and encounters data; future Medicaid health information technology implementation will augment this data
  • Board member Dr. Elena Marin noted that it is important not to leave providers out when sharing data
  • Board member Dr. Susan Strate noted the institute should emphasize barriers to providers that prevent them from accessing all pertinent data
  • Board member Dr. Patrick Carter asked if HHSC is studying the Medicare Advantage program as a model        
    • Within the comprehensive review, many programs in Texas and elsewhere are being studied and suggestions are welcome

 
Jimmy Blanton, HHSC

  • HHSC is working to streamline data collection and analysis
  • Communicating with CMS to find a way to receive Medicaid data to increase the understanding of dual eligible populations
  • Working to enable researchers to access Medicare and Medicaid data sets
  • Strate asked what type of recommendations would enable HHSC to collect more data and remove barriers to enable quality sharing and analytics
    • More communication across data groups in the enterprise is key; formalizing such an idea would be helpful
  • Board member Dr. Ronald Luke noted that the Sunset process should be fully utilized this coming session; administrative simplification, removal of barriers to data sharing, etc. should all be considered while keeping in mind that many changes will be and can be made because of Sunset
  • Strate noted that one administrative barrier is that doctors are asked to report fee for service type information while working within a capitated model; does not fully align with trying to produce quality outcomes
  • Blanton noted that many times small claims data does not make it to data sets creating a hole in that data
  • There are also informational gaps in behavioral health, long term services and supports, end of life care, pediatric and pregnancy data
  • Carter asked why HHSC isn’t getting clinical data only administrative data
    • There is a great deal of discussion on how to enhance administrative data which is a long term goal; one barrier has been synchronizing what information is used to produce MCO report cards and developing information that is more useful to physicians

 
Ramdas Menon, Director of Health Information Technology (HIT), HHSC

  • Using health information exchanges as a vehicle to tap into data is one goal for improving analytics
  • Trying to put together a proposal to receive funding from CMS for increasing HIT infrastructure
    • Want to merge clinical data and quality data bringing in clinical data through the federated health information exchange network
    • There are a lot of sensitive policy and legal areas that must be managed

 
Action Items for the Board from Work Group A:

  • Getting data to providers
  • Implementing quality strategies (looking at Medicare Advantage)
  • Making progress toward improving data outcomes for behavioral health and long term services and supports
  • Identifying barriers to data collection
  • Finding approaches to take for collecting data from small population health plans
  • How to get more clinical data into quality and efficiency programs