Oregon Effort Incentivizes Health Metrics for Kindergarten Readiness

Preparing a child for school success and the start of kindergarten is one of the most important goals of early childhood care and education. While educators and child development experts would agree that physical, oral, and behavioral health play a major role in a child’s readiness for kindergarten, Oregon and other states have struggled to determine the specific role that the health care system can and should play in ensuring young children arrive at school ready to learn.

What we do know is that what is measured is what gets done. Furthermore, metrics tied to  financial incentives create a targeted focus and drive improvements in health care quality and outcomes. An effort in Oregon is leveraging the transformative power of metrics to bolster the health system’s role and responsibility for kindergarten readiness.

Oregon launched its health system reform in 2012 with the creation of a new health care delivery model through regional Coordinated Care Organizations (CCOs). CCOs are responsible for managing health care for Oregon Health Plan (Medicaid) members. A cornerstone of this model includes accountability for performance and outcomes, in part through an innovative CCO Quality Incentive Program.

The Oregon Health Authority (OHA) monitors performance on a large set of quality metrics, and CCOs receive annual financial rewards for meeting specified targets on a subset of these “incentive metrics.” The measures are selected by the members of the Metrics and Scoring Committee, a public decision-making body established in Oregon statute with members appointed by the health authority director.

In Oregon, incentive metrics have been extremely effective at boosting outcomes. For example, the developmental screening rate for children 3 and under has improved dramatically since it became an incentive measure in 2012. During this period, the screening rate has increased from 20.9 to 69 percent in 2017.

CCOs, and the health systems they coordinate, have the opportunity to play a critically important role in advancing the state’s kindergarten readiness goal. Driven by a strong vision and growing energy, the Metrics and Scoring Committee sponsored the Health Aspects of Kindergarten Readiness (HAKR) Technical Workgroup.

The workgroup, convened by Children’s Institute and the Oregon Health Authority with support from the Oregon Pediatric Improvement Partnership, recently concluded a year-long process and has issued a set of measure recommendations to drive health system improvements and investments upstream.

The workgroup proposed a strategy that includes four measures across multiple areas of children’s health and development to be rolled out as CCO incentive metrics over the next few years. The recommendations jointly focus on children’s physical, oral, developmental, and social-emotional health – all critical components of kindergarten readiness. These include regular visits to doctors and dentists and a focus on addressing social-emotional health.

We recently got good news: The four-part measurement strategy was endorsed by the Metrics and Scoring Committee, which signals their initial commitment to implementing recommendations over the next several years. An additional governor-appointed public committee, the Health Plan Quality Metrics Committee, which curates a menu of performance measures across CCOs, private coverage for public employees and educators, and the health insurance exchange,  also endorsed the recommendations. That committee’s support broadens the potential impact of these measure recommendations to all children in Oregon, not just the 49 percent of children who are covered by Medicaid.

Reflecting on the past year and a half, we attribute the workgroup’s success largely to a few key factors. First, we took great care to assemble a diverse and multidisciplinary workgroup that included pediatricians, CCO representatives, early learning program representatives, health care quality measurement experts, and consumer representatives.

Second, we incorporated family input at multiple phases of the effort. Prior to launching the workgroup, Children’s Institute worked with Portland State University to conduct family focus groups across the state to hear from families about their needs and priorities related to their children’s health and kindergarten readiness. Those focus group findings informed the workgroup’s process and recommendations.

Third, the workgroup did the important and foundational work of developing a conceptual framework and measurement criteria that guided the work and allowed for thoughtful review of the metrics under consideration. Finally, the workgroup wrestled with the tension of balancing our long-term vision for improving kindergarten readiness with the current state of quality measures available.

While we do not have perfect measures, our approach is feasible to implement in the near-term and fits within the parameters of the Metrics and Scoring Program, while also propelling Oregon toward greater transformation, integration, and cross-sector collective action.

Oregon is embracing this opportunity to advance its kindergarten readiness goals through health care quality measurement. We are hopeful that this work will shine a light on the importance of children’s healthy development and will shift attention and investments to young children and their families, where we know they can make an abundant difference.

Elena Rivera is a guest blogger and Senior Health Policy and Program Advisor at Children's Institute of Oregon.