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Maine SIM Evaluation Subcommittee July 2015. July 22, 2015. Today’s Agenda. Welcome, Introductions, and Goals for Today’s Meeting. Obtain committee input regarding core metric goal setting for MaineCare ;
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Maine SIM Evaluation Subcommittee July 2015 July 22, 2015
Welcome, Introductions, and Goals for Today’s Meeting • Obtain committee input regarding core metric goal setting for MaineCare; • Inform committee of findings from the Consumer Survey analysis & obtain feedback on opportunities for rapid cycle improvement; • Provide an updated review and demonstration of the ME SIM Dashboard.
Meeting Minutes Please see meeting minute handouts for June 24th • Suggested edits from Committee members? • Additional questions or clarifications? • Motion to approve as written or amended
MaineCare Core Measure Goals • See meeting materials distributed with meeting notice
Consumer Interviews – Methodology • A random sample of MaineCare enrollees was identified and stratified by their current involvement in key interventions (HH, BHH, and Accountable Communities). • A control group was also sampled for each of these interventions. • We matched the control groups to intervention groups along the following dimensions: • Gender • Age • Risk score • County (except for BHH) • Chronic conditions: Diabetes, Asthma, Eye & Neurological Conditions, Mental Health / Substance Abuse, SPMI, Behavioral Health Disorders • Each intervention and control group was further stratified by adult and child enrollees.
Consumer Interviews – Methodology continued • Consumers were sent an initial survey invitation letter and then contacted by phone. Those who could not be reached by phone were mailed a paper copy of the survey to complete. • A goal of 1,500 completed surveys was set. Market Decisions Research drew a total of 6,078 cases from the provided sample. • Data Collection began on April 25 and was completed by July 7, 2015.
Consumer Interviews – Methodology • Weighting was performed to account for non-response and design effects. Raked weighting was conducted to normalize the results to the overall population: • By Intervention and Control group • Within each group by age, gender and region of the state
Consumer Interviews – Understanding Composites and Domains • Composite measures (also known as reporting composites), which combine results for closely-related items that have been grouped together. • Psychometric analyses also indicate that they are reliable and valid measures of patients’ experiences. (CAHPS Clinician & Group Surveys and Instructions, 2012) • Composites ranged from 1 to 5 items. • Domains are a similar constructs to Composites, but are distinct in that they are measured and reported upon differently (see following slide). • Domains range from 3 to 9 items.
Consumer Interviews – Calculating Composites and Domains • Composite and Domain scores were calculated by assessing when a consumer had answered 50% or more of applicable items; those that had were included in calculations. • For Composite scores: • Each response category was assigned a score between 0 and 100 based on the number of available responses. • These scores were averaged together across all qualifying respondents to produce the final composite score. • For Domain scores: • Those that qualified were assessed for whether or not their response fell into one of the two top box categories (Strongly Agree, Somewhat Agree). • The reported domain score is the percent of individuals responding within those two top boxes, averaged across number of valid item responses.
Consumer Interviews – Preliminary Findings- Key to Tables • Reading the tables: • Cells highlighted in GREENare areas in which a group’s score is more positive than the same group in other areas. • Cells highlighted in ORANGEare areas in which a group’s score is less positive than the same group in other areas. • BOLD cells show scores in which the intervention group scored 10 or more points higher than the control group. • ITALICIZED cells show scores in which the intervention group score 10 or more point lower than the control group. • Note that these represent large differences in scores, but do not necessarily rise to the level of statistical significance. Significance tests will be run for final reporting. • Significance testing is an important tool, but not necessary to identify areas of focus for quality improvement measures.
Preliminary Findings – Domain Scores Note: Domain scores are calculated by methods other than those used to calculate Composite scores; the two cannot be reliably compared.
Composite Item Scores • The following slides present the survey items which factor into composite scores in which ME SIM Intervention Groups scores were the least positive. • The following scores are presented using the Top Box method; the rate at which consumers used the most positive response available to describe their interaction (i.e., % answering “always” or “yes”).
Composite Item – Provider’s Attention to Your Child’s Growth and Development (Child) (preliminary findings)
Composite Item – Providers Pay Attention to Your Mental or Emotional Health (Adult) (preliminary findings)
Composite Item – Providers Support You in Taking Care of Your Own Health (preliminary findings)
Domain Item Scores • The following slides present the survey items which factor into Domain scores in which ME SIM Intervention Groups scores were least positive. • The following scores are presented using the Top Box method; the rate at which consumers used the most positive response available to describe their interaction (% strongly agree). • Note the difference in scoring methodology here compared to the higher level Domain scores. While these item scores display only on the most positive response, Domain scores used the two most positive responses(% strongly agree, % somewhat agree).
Individual Item Scores • The following slides present the survey items which did not factor into either Composite or Domain scores, but stood out as areas of particular interest due to the focus of ME SIM. • Individual items have been grouped into areas of broad thematic focus in order to better highlight areas of success and potential improvement. • The following scores are presented using the Top Box method; the rate at which consumers used the most positive response available to describe their interaction.
Individual Items – Coordination of Care (preliminary findings)
Individual Items – Coordination of Care (preliminary findings continued)
Individual Items – Coordination of Care -Mental Health Counseling or Treatment (preliminary findings)
Individual Items – Support by Providers (preliminary findings)
Consumer Interviews – Summary of preliminary findings • Overall, consumers felt that provider communicated well with them and shared information; however, they felt that providers did not do as well listening and soliciting information from consumers and involving them in their own care. • Consumers were generally more positive about performance in process measures than outcomes. (This is not unusual in such surveys) • Patients are general satisfied with how they are treated; but there are still opportunities for improvement among all groups to increase their level of satisfaction
Consumer Interviews – Accountable Communities and Stage A HHs • Summary of preliminary findings for Accountable Communities and Stage A HHs: • While patient and provider communication is rated high, one area for potential improvement is listening more to patients and engaging their input into their health care. • There are opportunities to solicit information on personal problems, factors that make it hard to take care of health, and – for children – learning abilities, moods, and behaviors. • Coordination of care seems to be both a strength and an area for potential improvement. While Stage A HHs appear to be coordinating with behavioral health providers, consumers indicated that providers did not do as well coordinating care with other providers and remaining informed about developments in a consumer’s care.
Consumer Interviews – Stage B Health Homes • Summary of preliminary findings for Stage B HH, the areas of opportunity are in functioning and outcomes. • Successes: Stage B HH consumers felt: • Their BH providers were aware of services they or their children receive from other doctors, home care, and/or community agencies. • Their BH providers helped them find or keep a job • As a direct result of current services, they or their children are doing better in school and/or work. • Opportunities: Stage B HH consumers also felt: • Services they received did little to improve their symptoms. • Services they received did little to improve their children’s ability to do things their children want to do.
Consumer Interview preliminary findings Next steps
SIM Dashboard & Preliminary Data • Status Update • Next steps- webinar to be scheduled prior to August Evaluation Committee meeting
Next Steps • Next Meeting • August 26, 2015, 3-5 pm Conference room A 35 Anthony Avenue, Augusta • Future Discussion Topics • Sustainable Research Collaborative • Provider, Stakeholder, interview preliminary action items • Continued discussion- data analysis • Target setting progress- Commercial & Medicare • Follow up on identified risks as necessary
