Commonwealth of Massachusetts Executive Office of Health and

Commonwealth of Massachusetts Executive Office of Health and Human Services EOHHS QUALITY MEASUREMENT ALIGNMENT TASKFORCE Meeting #6 October 26, 2017

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Agenda Welcome Recap of 10-10-17 Meeting Decisions & Discussion of Follow-Up Items Continued Review of Candidate Measures Next Steps 2

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Agenda Welcome Recap of 10-10-17 Meeting Decisions & Discussion of Follow-Up Items Continued Review of Candidate Measures Next Steps 3

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Recap of 10-10-17 Meeting Decisions 1. The Taskforce tentatively endorsed the three following preventive care measures: Pediatric/Adolescent Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists Chlamydia Screening (Ages 16-20) Chlamydia Screening (Ages 21-24) 2. The Taskforce affirmed its prior tentative endorsement of the two following pediatric behavioral health measures: Metabolic Monitoring for Children and Adolescents on Antipsychotics Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics 4

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Recap of 10-10-17 Meeting Decisions (Cont’d) 3. The Taskforce requested additional information on “Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists” Can the measure be operationalized? Is a primary care provider held accountable for knowledge of care prevention intervention by a different provider? The following guidance was provided by CMS: Eligible encounters include both primary care visits and dental visits. As the intent of the measure is for children to receive the fluoride varnish application, it should be acceptable if a primary care physician reports in the EHR that the activity was completed elsewhere. 5

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Recap of 10-10-17 Meeting Decisions (Cont’d) 4. The Taskforce requested information regarding the evidence supporting “Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics.” The measure steward indicated that overall the quality of evidence regarding use of first-line psychosocial care for children and adolescents on antipsychotics is moderate to high. NQF most recently reviewed and re-endorsed this measure in May 2016. More information on the evidence cited in the steward’s submission to NQF can be found in the NQF submission file distributed with the meeting materials. 6

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Recap of 10-10-17 Meeting Decisions (Cont’d) 4. The Taskforce requested information regarding the evidence supporting “Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics.” MassHealth confirmed that the number of estimated ACOs the meet the denominator threshold is correct. NQF 2800: Metabolic Monitoring for Children and Adolescents on Antipsychotics 16 out of 17 ACOs have a sufficient denominator size NQF 2801: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics 6 out of 17 ACOs have a sufficient denominator size See slide 29 for more information on the denominator for these measures. 7

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Recap of 10-10-17 Meeting Decisions (Cont’d) 5. The Taskforce deferred a decision on the following depression screening measures. One member wanted to know how NQF 0418 differed from NQF 3148. NQF 0418, NQF 3148, and NQF 3132 all have the same numerator and denominator statements, but utilize different data sources. NQF 0418 (parent measure): claims and clinical data NQF 3148: claims and registry data NQF 0418/NQF NQF 3132: 3148 electronic health records NCQA HEDIS Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. The percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care within 30 days. Note: a PHQ-9 is an acceptable follow-up to a PHQ-2 only if performed on the same day as the PHQ-2 and if PHQ-9 results are negative. Note: a PQQ-9 is an acceptable follow-up to a PHQ-2 if performed on the same day as the PHQ-2. 8

Recap of 10-10-17 Meeting Decisions (Cont’d) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count 0418 Screening for Clinical Depression and Follow-Up Plan (Ages 12 ) CMS Claims/Clinical Data 5 3148 Screening for Clinical Depression and Follow-Up Plan (Ages 12 ) CMS Claims/Registry Data 0 3132 Screening for Clinical Depression and Follow-Up Plan (Ages 12 ) CMS EHR Data 0 NA Depression Screening and Follow-Up for Adolescents and Adults NCQA HEDIS Electronic Clinical Data Systems 0 Depression: Utilization of the PHQ-9 Tool MNCM Clinical Data 2 Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults*, NCQA HEDIS Electronic Clinical Data Systems 1 Screening Monitoring 0712 NA * MassHealth ACO/DSRIP measure. MassHealth modified this measure by defining the population as MassHealth members in the ACO, excluding patients 65 and older, and permitting ACOs to report on the measure based on a sample population via medical records. 9

Recap of 10-10-17 Meeting Decisions (Cont’d) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count Remission 0710 Depression: Remission at Twelve Months** MNCM Clinical Data 2 1885 Depression: Response at Twelve Months - Progress Towards Remission** MNCM Clinical Data 1 Depression Remission or Response for Adolescents and Adults*, NCQA HEDIS Electronic Clinical Data Systems 1 NA * MassHealth ACO/DSRIP measure. ** CMS/AHIP CQMC measure. MassHealth modified this measure by defining the population as MassHealth members in the ACO, excluding patients 65 and older, and permitting ACOs to report on the measure based on a sample population via medical records. 10

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Agenda Welcome Recap of 10-10-17 Meeting Decisions & Discussion of Follow-Up Items Continued Review of Candidate Measures Next Steps 11

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Distribution of Measure Specifications In advance of each meeting, Taskforce staff will distribute the specifications for each measure included in the meeting materials. Specifications will not be printed for the meeting. NCQA HEDIS has granted Bailit Health permission to distribute the specifications to the Taskforce: Reproduced with permission from HEDIS 2018 Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). To obtain copies of this publication, contact NCQA Customer Support at 888-2757585 or visit www.ncqa.org/publications. Please refrain from redistributing the specifications. 12

Behavioral Health Care Measures: Adult (Cont’d) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count Mental Health 0105 0105 Antidepressant Medication Management - Effective Acute Phase Treatment Antidepressant Medication Management - Effective Continuation Phase Treatment NCQA HEDIS Claims 7 NCQA HEDIS Claims 5 Clinical Data 1 Substance Abuse NA AMA-PCPI (Adapted) Opioid Addiction Counseling*,& *MassHealth ACO/DSRIP measure. & There are also several opioid prescriber measures available (both HEDIS and non-HEDIS). 13

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Behavioral Health Care Measures: Adult (Cont’d) NQF# Measure Label Utilization Emergency Department Utilization for Severe Mental NA Illness/Substance Use Disorder (SMI/SUD) Population* Hospital Admissions for Severe NA Mental Illness/Substance Use Disorder (SMI/SUD) Population* Utilization of Behavioral Health Community Partner (BH CP) NA Support(s) by BH CP Assigned Members* Steward *MassHealth ACO/DSRIP measure. 14 Data Source Count MA EOHHS Claims 1 MA EOHHS Claims 1 MA EOHHS Claims 1

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Behavioral Health Care Measures: Adult and Pediatric NQF# Measure Label Mental Health Follow-Up After Hospitalization for 0576 Mental Illness (30-Day)* Steward NCQA HEDIS Follow-Up After Hospitalization for NCQA HEDIS Mental Illness (7-Day)* Utilization Utilization of Outpatient Behavioral Health Services for Population at Risk for Serious Mental Illness NA MA EOHHS (SMI), Serious Emotional Disturbance (SED), and/or Substance Use Disorder (SUD)* 0576 *MassHealth ACO/DSRIP measure. 15 Data Source Count Claims 7 Claims 7 Claims 1

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Behavioral Health Care Measures: Adult and Adolescent NQF# Measure Label Substance Abuse Initiation and Engagement of Alcohol and Other Drug 0004 Dependence Treatment – Initiation* Initiation and Engagement of Alcohol and Other Drug 0004 Dependence Treatment – Engagement* Substance Use Disorder (SUD) Evaluation in the ED following NA Naloxone Administration or Suspected SUD& Steward Data Source Count NCQA HEDIS Claims/Clinical Data 5 NCQA HEDIS Claims/Clinical Data 3 MA Department Claims/Clinical of Public Health Data 0 *MassHealth ACO/DSRIP measure. & This measure does not meet our criteria for consideration, but is brought forward for consideration because it has been proposed by DPH and fills a gap in care 16

Acute Care Measures: Cardiovascular (Adult) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count Cardiovascular 0071 Persistence of Beta-Blocker Treatment After a Heart Attack**, # NCQA HEDIS Claims 4 Clinical Data 2 Clinical Data 1 Clinical Data 1 Clinical Data 1 Cardiovascular (Facility-based) 0733 0715 0964 2459 The Society Operative Mortality Stratified by the 5 of Thoracic STAT Mortality Categories** Surgeons Standardized Adverse Event Ratio for Boston Children 18 Years of Age Children's Undergoing Cardiac Catheterization** Hospital Therapy with Aspirin, P2Y12 Inhibitor, American and Statin at Discharge Following College of PCI in Eligible Patients** Cardiology In-hospital Risk-Adjusted Rate of American Bleeding Events for Patients College of Undergoing PCI** Cardiology **CMS/AHIP CQMC measure. # This measure does not have opportunity for improvement. 17

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Acute Care Measures: Cardiovascular (Adult) (Cont’d) NQF# Measure Label Cardiovascular (Facility-based) 30-day All-cause Risk-standardized Mortality Rate Following Percutaneous Coronary Intervention 0535 (PCI) for Patients without ST Segment Elevation Myocardial Infarction (STEMI) and without Cardiogenic Shock** 30-day All-cause Risk-standardized Mortality Rate following Percutaneous Coronary Intervention 0536 (PCI) for Patients with ST Segment Elevation Myocardial Infarction (STEMI) or Cardiogenic Shock** **CMS/AHIP CQMC measure. 18 Steward Data Source Count American College of Cardiology Claims/Clinical Data 1 American College of Cardiology Claims/Clinical Data 1

Acute Care Measures: Orthopedic Care (Adult) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source NA American Total Knee Replacement: Association of Identification of Implanted Prosthesis Hip and Knee Clinical Data in Operative Report Surgeons NA Total Knee Replacement: Preoperative Antibiotic Infusion with Proximal Tourniquet NA NA American Association of Hip and Knee Surgeons American Total Knee Replacement: Shared Association of Decision-Making: Trial of Hip and Knee Conservative (Non-surgical) Therapy Surgeons American Total Knee Replacement: Venous Association of Thromboembolic and Cardiovascular Hip and Knee Risk Evaluation Surgeons Count 1 Clinical Data 1 Clinical Data 1 Clinical Data 1 NA Functional Status Assessment for Total Knee Replacement CMS Clinical Data 1 NA Functional Status Assessment for Total Hip Replacement CMS Clinical Data 1 19

Acute Care Measures: Pulmonology (Multiple Ages) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis NCQA HEDIS Claims/Clinical Data 7 Appropriate Treatment for Children with Upper Respiratory Infection# NCQA HEDIS Claims/Clinical Data 7 Appropriate Testing for Children with Pharyngitis# NCQA HEDIS Claims 6 Adult 0058 Pediatric 0069 0002 (no longer endorsed) This measure does not have opportunity for improvement. # 20

Chronic Illness Care Measures: Pulmonology (Multiple Ages) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count 0577 Use of Spirometry Testing in the Assessment and Diagnosis of COPD NCQA HEDIS Claims 3 NA COPD or Asthma Admission Rate in Older Adults*, CMS Claims 1 NCQA HEDIS Claims 0 NCQA HEDIS Claims 0 Adult 2856 Pharmacotherapy Management of COPD Exacerbation - Bronchodilator 2856 Pharmacotherapy Management of COPD Exacerbation – Systemic Corticosteroid * MassHealth ACO/DSRIP-only measure. Ages 40-64. Ages 40 . 21

Chronic Illness Care Measures: Pulmonology (Multiple Ages) [Cont’d] CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# Measure Label Steward Data Source Count Adult and Pediatric 1799 (no longer endorsed) 1800 NA Medication Management for People with Asthma** NCQA HEDIS Claims 6 Asthma Medication Ratio NCQA HEDIS Claims 6 Clinical Data 1 Minnesota Community Measurement Optimal Asthma Control **CMS/AHIP CQMC measure. 22

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Chronic Illness Care Measures: Cardiovascular (Adult) NQF# 0018 Measure Label Controlling High Blood Pressure** NA Controlling High Blood Pressure** 0068 0070 0081 Steward NCQA NCQA HEDIS Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic** Coronary Artery Disease (CAD): Beta-Blocker Therapy — Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF 40%)** Heart Failure (HF): AngiotensinConverting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)** **CMS/AHIP CQMC measure. 23 Data Source Clinical Data Count 4 Clinical Data 8 NCQA Clinical Data 2 AMA-PCPI Clinical Data 2 AMA-PCPI Claims/Clinical Data 2

Chronic Illness Care Measures: Cardiovascular (Adult) (Cont’d) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT NQF# 0083 1525 0066 0067 0119 2514 Measure Label Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)** Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy** Steward 24 Count AMA-PCPI Claims/Clinical Data 2 AMA-PCPI Clinical Data 2 Claims/Clinical Data 1 Claims/Clinical Data 1 Clinical Data 1 Claims/Clinical Data 1 Chronic Stable Coronary Artery American Disease: ACE Inhibitor or ARB College of Therapy - Diabetes or Left Ventricular Cardiology Systolic Dysfunction (LVEF 40%)** American Chronic Stable Coronary Artery College of Disease: Antiplatelet Therapy** Cardiology The Society Risk-Adjusted Operative Mortality for of Thoracic CABG** Surgeons Risk-Adjusted Coronary Artery The Society Bypass Graft (CABG) Readmission of Thoracic Rate** Surgeons **CMS/AHIP CQMC measure. Data Source

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Agenda Welcome Recap of 10-10-17 Meeting Decisions & Discussion of Follow-Up Items Continued Review of Candidate Measures Next Steps 25

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Next Steps: Meeting Schedule Domain Preventive Care Behavioral Health Care Acute Care (e.g., cardiac care and orthopedic care) Chronic Illness Care (including cancer care) Maternity Care Care Coordination Integration Team-based Care Equity (disparities) Social Determinants of Health Health Behaviors Patient/Provider Communication Patient Engagement Patient Experience Relationship-Centered Care Opioid Prescribing and Treatment Hospital Care 26 Estimated Schedule Meeting #3 and #4 Meeting #4 and #5 Meeting #5 and #6 Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting Meeting #6 and #7 #7 #8 #8 #8 #8 #8 #8 #9 #9 #9 #9 #9 #9 (TBD)

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Reference Slides The following slides may be helpful to have available for reference during today’s meeting. 27

Follow-Up: Measure Assessment – Denominator Counts for Behavioral Health Measures Overall: Member volume for 17 ACOs was compared to MCOs. Total ACO member volume: 850K ; Total MCO member volume (in CY2015): 836,580. 11 ACOs have volume similar to the lowest-volume MCO. Measure-level: 0108–C&M: 12 ACOs would be unlikely to meet a denominator threshold of 30. Need a minimum of 40K total membership to meet a threshold of 30. 2800, NA: 1 ACO would be at risk of not meeting the denominator threshold of 30. Its member volume is significantly lower than the smallest MCO. 2801: 11 ACOs would be unlikely to meet the denominator threshold of 30. Need a minimum of 60K total membership to meet a threshold of 30. 1365: Major Depressive Disorder has a denominator of 9,159 for a population of 836K. Given similar ACO volume, there would be sufficient denominator (range: 142-1,435). NQF# Measure Label Steward 0108 0108 2800 2801 NA 105 4 1365 Follow-Up Care for Children Prescribed ADHD Medication-Initiation Phase Follow-Up Care for Children Prescribed ADHD Medication-Con't and Maintenance Metabolic Monitoring for Children and Adolescents on Antipsychotics Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics Use of Multiple Concurrent Antipsychotics in Children and Adolescents Antidepressant Medication Management Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment NCQA HEDIS NCQA HEDIS NCQA HEDIS NCQA HEDIS NCQA HEDIS NCQA HEDIS NCQA HEDIS AMA-PCPI Total MassHealth member count (not measure-specific) *Source: HEDIS 2016 data Measure Denominator* MassHealth Low Low-Mid High Member member member member Data Source All MCOs Volume volume volume volume (CY2015) MCO MCO MCO Claims 5,017 3,346 90 128 1,337 Claims 1,113 672 23 26 193 Claims 4,402 2,064 72 329 434 Claims 1,228 657 16 83 145 Claims 3,618 1,671 61 263 348 Claims 24,159 18,280 555 902 5,663 Claims/Clinical 43,203 32,396 1,354 2,214 10,599 Clinical 10,443 9,159 1,202,129 28 836,580 31,024 80,856 187,240

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Follow-Up: Measure Assessment – Denominator Counts for Behavioral Health Measures (Cont’d) NQF 2800: Metabolic Monitoring for Children and Adolescents on Antipsychotics (4,402 Total) Largest eligible population (4,402 total), broadest denominator Triggering event for denominator: More than one anti-psych prescription during the measurement year (i.e., one Rx on one date, a second Rx on the same or different date) NQF 2801: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (1,228 Total) Event is a single Rx for antipsychotic meds, but with significant exclusions: Negative medication history exclusion (does not apply to #2800/APM) Members for whom first-line antipsychotic meds may be appropriate - this includes kids with schizophrenia or bipolar. (does not apply to NQF 2800) Use of Multiple Concurrent Antipsychotics in Children and Adolescents (3,618 Total) Triggering event for denominator: 90 consecutive days of any antipsychotic Rx during the year (similar to APM, but smaller denominator with the 90 consecutive days criteria) 29

Behavioral Health Screening: CY2014 – 2017 (1Q2017) CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT 2014-2017 TOTAL VISITS TOTAL SCREENS % VISITS SCREENS W VISIT W/SCREENS % SCREENS W/VISITS TOTAL SCREENS W/MODIFIER 2014 2015 2016 552,326 555,651 574,137 402,862 393,820 396,997 392,407 381,089 384,839 71.05% 68.58% 67.03% 97.40% 96.77% 96.94% 401,434 392,944 395,467 JAN - MAR 2017 132,007 89,648 87,189 66.05% 97.26% 89,461 % W/O % BHNEED MODIFIER 9.46% 0.08% Reference/Resources: Header Definitions: www.mass.gov/eohhs/docs/masshealth/cbhi/reports/bhscreening-data-heading-definitions.pdf Modifiers: www.mass.gov/eohhs/docs/masshealth/bull-2011/all-211.pdf Screening requirement, list of MassHealth-approved screening tools, regulations and training resources for providers: www.mass.gov/eohhs/consumer/insurance/cbhi/cbhi-screening/ Reports: www.mass.gov/eohhs/consumer/insurance/cbhi/cbhi-data-and-reports/cbhi-datareports.html 30

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Behavioral Health Screening: Current and Cumulative by Age Group Quarter 1: January 1 2017 - March 31 2017 AGEGRPVISIT 1 6mos 2 6mos to 2yrs 3 3yrs to 6 yrs 4 7 yrs to 12 yrs 5 13 yrs to 17 yrs 6 18 yrs to 20 yrs TOTAL VI TOTAL SCREENS SITS SCREENS W VISIT 24,365 35,408 21,465 25,706 17,855 7,208 11,181 28,128 16,531 19,007 12,100 2,701 11,037 27,720 16,153 18,228 11,583 2,468 % % VISITS SCREENS W/SCREENS W/VISITS 45.30% 78.29% 75.25% 70.91% 64.87% 34.24% 98.71% 98.55% 97.71% 95.90% 95.73% 91.37% TOTAL SCREENS W/MODIFIER % BHNEED 11,165 28,045 16,508 18,970 12,081 2,692 2.63% 7.52% 11.30% 12.42% 12.42% 12.67% % W/O MODIFIER 0.11% 0.09% 0.06% 0.06% 0.03% 0.19% Summary: December 31 2007 - March 31 2017 AGEGRPVISIT TOTAL VI TOTAL SCREENS SITS SCREENS W VISIT 1 6mos 882,434 344,196 2 6mos to 2yrs 1,253,701 884,892 3 3yrs to 6 yrs 776,570 576,398 4 7 yrs to 12 yrs 911,693 687,384 5 13 yrs to 17 yrs 673,212 469,811 6 18 yrs to 20 yrs 224,180 83,215 336,179 869,428 562,311 666,266 453,187 78,552 % % VISITS SCREENS W/SCREENS W/VISITS 38.10% 69.35% 72.41% 73.08% 67.32% 35.04% 31 97.67% 98.25% 97.56% 96.93% 96.46% 94.40% TOTAL SCREENS W/MODIFIER % BHNEED 325,868 828,654 543,916 651,215 444,204 78,906 1.75% 5.17% 9.45% 10.78% 10.58% 11.48% % W/O MODIFIER 5.20% 6.15% 5.47% 5.09% 5.26% 4.97%

Behavioral Health Screening: CY2014 – CY2016 by Age Group CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT 2014 AGEGRPVISIT 1 6mos 2 6mos to 2yrs 3 3yrs to 6 yrs 4 7 yrs to 12 yrs 5 13 yrs to 17 yrs 6 18 yrs to 20 yrs TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 92,323 141,261 93,846 112,617 81,227 31,052 42,523 111,775 76,856 94,337 64,106 13,265 41,462 109,806 75,053 91,470 61,944 12,672 44.91% 77.73% 79.97% 81.22% 76.26% 40.81% % SCREENS W/VISITS 97.50% 98.24% 97.65% 96.96% 96.63% 95.53% TOTAL SCREENS W/MODIFIER % BHNEED 42,384 111,413 76,595 94,031 63,833 13,178 % W/O MODIFIER 0.33% 0.32% 0.34% 0.32% 0.43% 0.66% 2015 AGEGRPVISIT 1 6mos 2 6mos to 2yrs 3 3yrs to 6 yrs 4 7 yrs to 12 yrs 5 13 yrs to 17 yrs 6 18 yrs to 20 yrs TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 96,806 137,626 91,997 115,560 82,756 30,906 46,155 110,058 73,296 91,240 60,379 12,692 44,406 107,425 71,222 88,175 57,885 11,976 45.87% 78.06% 77.42% 76.30% 69.95% 38.75% % SCREENS W/VISITS 96.21% 97.61% 97.17% 96.64% 95.87% 94.36% TOTAL SCREENS W/MODIFIER % BHNEED 46,058 109,823 73,141 91,032 60,248 12,642 % W/O MODIFIER 0.21% 0.21% 0.21% 0.23% 0.22% 0.39% 2016 AGEGRPVISIT 1 6mos 2 6mos to 2yrs 3 3yrs to 6 yrs 4 7 yrs to 12 yrs 5 13 yrs to 17 yrs 6 18 yrs to 20 yrs TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 98,325 142,885 92,558 121,336 86,413 32,620 45,547 115,410 72,461 91,098 59,773 12,708 44,444 112,923 70,376 87,975 57,260 11,861 45.20% 79.03% 76.03% 72.51% 66.26% 32 36.36% % SCREENS W/VISITS 97.58% 97.85% 97.12% 96.57% 95.80% 93.33% TOTAL SCREENS W/MODIFIER % BHNEED 45,427 114,911 72,208 90,770 59,495 12,656 % W/O MODIFIER 0.26% 0.43% 0.35% 0.36% 0.47% 0.41%

Behavioral Health Screening: Current and Cumulative by Region CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Quarter 1: January 1 2017 - March 31 2017 REGION TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 1 - Western Region 2 - Central Region 3 - Northeast Region 4 - Metro West Region 5 - Southeast Region 6 - Boston Region N/A Out of State 20,635 12,479 19,942 14,159 24,820 28,938 10,905 129 18,140 9,293 13,872 6,886 18,625 17,716 5,036 80 17,595 9,023 13,436 6,756 18,354 17,003 4,942 80 85.27% 72.31% 67.38% 47.72% 73.95% 58.76% 45.32% 62.02% % SCREENS W/VISITS TOTAL SCREENS W/MODIFIER 97.00% 97.09% 96.86% 98.11% 98.54% 95.98% 98.13% 100.00% 18,134 9,275 13,836 6,869 18,605 17,647 5,015 80 % BHNEED 12.52% 9.51% 9.94% 10.93% 5.60% 10.01% 7.58% 0.00% % W/O MODIFIER 0.01% 0.00% 0.14% 0.00% 0.00% 0.26% 0.02% 0.00% Summary: December 31 2007 - March 31 2017 REGION TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 1 - Western Region 782,503 2 - Central Region 407,323 3 - Northeast Region 719,541 4 - Metro West Region 533,589 5 - Southeast Region 929,598 6 - Boston Region 1,134,471 N/A 212,417 Out of State 2,348 594,244 272,288 453,622 278,612 673,868 657,790 114,232 1,240 580,191 263,175 436,833 273,909 663,431 635,343 111,836 1,205 74.15% 64.61% 60.71% 51.33% 71.37% 56.00% 52.65% 51.32% 33 % SCREENS W/VISITS 97.64% 96.65% 96.30% 98.31% 98.45% 96.59% 97.90% 97.18% TOTAL SCREENS W/MODIFIER 578,372 266,311 429,196 249,868 657,139 580,068 110,620 1,189 % BHNEED 10.07% 8.92% 8.30% 4.96% 6.43% 8.01% 6.60% 11.77% % W/O MODIFIER 2.60% 2.02% 5.09% 10.15% 2.35% 11.56% 3.01% 3.79%

Behavioral Health Screening: CY2014 - CY2016 by Region CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT 2014 REGION TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 1 - Western Region 81,454 2 - Central Region 51,379 3 - Northeast Region 86,056 4 - Metro West Region 64,153 5 - Southeast Region 103,914 6 - Boston Region 126,114 N/A 39,058 Out of State 198 67,884 37,829 60,394 38,817 84,862 88,648 24,411 17 66,353 36,573 57,859 38,186 83,752 85,735 23,939 10 81.46% 71.18% 67.23% 59.52% 80.60% 67.98% 61.29% 5.05% % SCREENS W/VISITS 97.74% 96.68% 95.80% 98.37% 98.69% 96.71% 98.07% 58.82% TOTAL SCREENS W/MODIFIER % BHNEED 67,849 37,699 60,187 38,743 84,761 87,792 24,395 8 % W/O MODIFIER 0.05% 0.34% 0.34% 0.19% 0.12% 0.97% 0.07% 52.94% 2015 REGION TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 1 - Western Region 84,340 2 - Central Region 53,220 3 - Northeast Region 84,171 4 - Metro West Region 61,519 5 - Southeast Region 103,979 6 - Boston Region 123,583 N/A 44,448 Out of State 391 71,651 39,396 60,929 33,919 82,339 85,025 20,412 149 69,993 37,749 57,597 33,396 80,926 81,261 20,023 144 82.99% 70.93% 68.43% 54.29% 77.83% 65.75% 45.05% 36.83% % SCREENS W/VISITS 97.69% 95.82% 94.53% 98.46% 98.28% 95.57% 98.09% 96.64% TOTAL SCREENS W/MODIFIER % BHNEED 71,624 39,268 60,810 33,854 82,246 84,623 20,375 144 % W/O MODIFIER 0.04% 0.32% 0.20% 0.19% 0.11% 0.47% 0.18% 3.36% 2016 REGION TOTAL VI TOTAL SC SCREENS % VISITS SITS REENS W VISIT W/SCREENS 1 - Western Region 86,360 2 - Central Region 55,197 3 - Northeast Region 87,320 4 - Metro West Region 62,313 5 - Southeast Region 107,334 6 - Boston Region 123,952 N/A 51,105 Out of State 556 71,317 41,458 65,890 31,450 82,541 80,488 23,555 298 69,808 40,037 62,079 31,004 81,397 77,048 23,181 285 80.83% 72.53% 71.09% 49.76% 75.84% 62.16% 45.36% 34 51.26% % SCREENS W/VISITS 97.88% 96.57% 94.22% 98.58% 98.61% 95.73% 98.41% 95.64% TOTAL SCREENS W/MODIFIER 71,298 41,294 65,414 31,375 82,431 79,952 23,421 282 % BHNEED % W/O MODIFIER 0.03% 0.40% 0.72% 0.24% 0.13% 0.67% 0.57% 5.37%

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Criteria for Candidate Set Candidate measures were selected using the following methodology: 1. Included in a domain identified by the Taskforce 2. Found in at least 2 “alignment” measure sets 3. Found in the CMS/AHIP Core Quality Measures Collaborative (CQMC) and/or the MassHealth ACO/DSRIP measure sets* We are reviewing candidate measures by domain, and within domain, grouped by age and measure *MassHealth ACO/DSRIP and CMS/AHIP CQMC measures are included for consideration even if focus, if applicable. they are not found in at least 2 “alignment” measure sets. 35

CONFIDENTIAL WORKING DRAFT – POLICY IN DEVELOPMENT Candidate Measure Sources Measures currently in use Measures found in national in APM contracts by measure sets: providers and payers: CMS/AHIP Core Quality Harvard Pilgrim Health Care Measures Collaborative (2017) (CQMC) [ACO/PCMH] Blue Cross Blue Shield of MA CMS Medicaid Child Core Set (2017) CMS Medicaid Adult Core Set Tufts Health Plan (2017) CMS Medicare Part C & D Star Measures found in local and Ratings Measures state measure sets: CMS Merit-based Incentive Boston Public Health Payment System (MIPS) Commission (2016) NCQA Health Plan Ranking MassHealth ACO (DSRIP) MassHealth MCO (Payment) Standard Quality Measure Set 36