CHIPRA Quality Demonstration Grant:

1. CHIPRA Quality Demonstration Grant:

2. A Look Through the Looking Glass Where we started Where we are Where we want to go

3. A Review: South Carolina chose categories: • CHIPRA Indicators: • Category A – Experiment with, and evaluate the use of, new measures for quality of Medicaid/ CHIP children’s health care • EHRs: • Category B – Promote the use of Health Information Technology (HIT) for the delivery of care for children covered by Medicaid/CHIP • Medical Home/Behavioral Health: • Category C – Evaluate provider-based models which improve the delivery of Medicaid/CHIP children’s health care services

4. Focus of SC Grant South Carolina believes that children will achieve the best health outcomeswhen they receive care through an integrated medical home that addresses all their health needs—both physical and mental—and participates in continuous quality improvement efforts.

5. The South Carolina grant has four key goals: • Quality:demonstrate that newly developed quality indicators can be successfully utilized in pediatric practices; • Technology:share key clinical data through a statewide electronic quality improvement network; • Innovation:develop a physician-led, peer-to-peer quality improvement network; and • Pediatrics:expand the use of pediatric medical homes to address mental health challenges of children in our state.

6. Year One = Planning YearFebruary 2010 – January 2011 • Staff hired; principal contractors identified • Planning & Steering Committee established • Selection of pediatric practices • HIT and reporting development • Evaluation planning • Baseline data gathering • Implementation of blog and tracking mechanisms • Submission of Final Operational Plan • First Learning Collaborative held • Participation payments made

7. Quality - To Date: “To demonstrate that newly developed quality indicators can be successfully utilized in pediatric practices” Pursuit of National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification by all participating practices. • 2011 standards were issued • Elements of the standards identified for discussion.

8. Quality - To Date: Collection of CHIPRA Quality Measures • CMS issued final 24 quality measures in Feb 2011 • Received ABP’s MOC Part IV approval on ADHD • 4 measures introduced at January’s Learning Collaborative • 3 additional quality measures will be introduced at the July Learning Collaborative

9. Quality - To Date: Utilization of Learning Collaboratives and the “Plan, Do, Study, Act”quality improvement cycle • PDSA cycles are being submitted and recorded • As of June 29, 2011, all 18 practices have been submitted at least one PDSA cycle. Over 94 have been documented. • Site visits will be made to all 18 practices by the end of April; participating lead practitioners accompanied Dr. Rushton on 9 visits.

10. TECHNOLOGY: update“To share key clinical data through a statewide electronic quality improvement network” Providing primary care physicians with HIT tools that will allow them to track their patient’s outcomes • Baseline assessments and on-site visits occurring • Estimates: 14 practices have EHRs; 1 in selection process; 3 are anticipated to need the CHIPRA Data Registry • CareEvolution is building the adapter(s) to extract data for quality reports. It is estimated that 5 will be able to transmit data by August 1.

11. TECHNOLOGY: update Technology and the generated reports will allow the practices to compare their performance to others. • All quality measures/technical specifications are being reviewed to determine what information needs to be captured from EHR and/or administrative claims. • Report design work is underway. • Goal: to show reports at July Learning Collaborative; reports to certain practices by September/October

12. INNOVATION“To develop a physician-led, peer-to-peer quality improvement network” Providing Behavioral Health Tools to primary care physicians • Academic detailing on ADHD indicator is occurring • 2011 is the development year for Behavioral Health • Site visits are occurring to gather information on current method of addressing mental health and the practice’s perceived need; formal assessment is planned during the Fall of 2011

13. Innovation – TO DATE Increasing linkage of organizations and resources with practices to provide additional resources. • Discussion on resources and linkages is occurring Learning Collaboratives to integrate and support • Learning Collaborative held January and July 2011 • 7 quality indicators highlighted • January: emergency department utilization, ADHD, developmental screening, and well-child visits) • July: Access, oral health, and CAHPS

14. PEDIATRICS “To expand the use of pediatric medical homes to address mental health challenges of children in our state.” Selectionof pediatricpractices • 18 heterogeneous practices • 2 stipend payments made to practices with signed MOAs • 18 site visits made by the Medical Director Working with the pediatric practices on becoming a NCQA medical home

15. PEDIATRICS – TO DATE Expanding the mental health services available in a pediatric setting • 2011 is planning year • QTIP staff hired and on-site visits occurring • Research and resource linkages being explored Quality improvement team within the pediatric setting • As of June 29, 2011, 58 meetings have been documented by 12 practices. • Blog is being used

16. Back to the Future Francis Rushton Says “We are going where no pediatrician has gone before” Where We Are Where We Want to Go

17. Year 2 PlansFebruary 2011 – Feb 2012 • Learning Collaboratives: July 23-24, 2011 and February 2012 • HIT assistance/development • Development of edge adapters • CHIPRA data registry developed • Continue to work on SCHIEx connection • Connection with EMR or Data Registry • Quality reporting available (Fall 2011) • Peer-to-peer comparisons • Building reporting systems

18. Year 2 Plans • Technical assistancesite visits • Will be scheduled for August – December 2011 with Medical Director • Peer-based technical assistance site visits • SCORxE will be making ADHD presentations • Development/Data Gathering • SCORxE to begin work on asthma • Continue development on Mental Health Integration • Baseline data due to National Evaluators • Additional areasof focus: • Additional quality indicators • Family Centered Care • NCQA – PCMH • CAHPS, provider integration surveys • SC and Federal Evaluation

19. Year 3 Projected Tasks • Learning Collaboratives • HIT assistance • Continue to work on SCHIEx connection • Quality reporting • Begin enhanced reimbursement development • NCQA- PCMH • Review of family involvement and family- centered care • Behavioral Health • To have training/certification program available • Begin incorporation of prevention strategies and treatment strategies

20. Year 4 and 5 Projected Tasks • Learning Collaboratives • Continued work on enhanced reimbursement • NCQA–PCMH (certification at levels 1, 2 or 3) • Family-centered care • Behavioral Health: Incorporation of prevention strategies and treatment strategies within practices

21. Now . . . Into Future Where We Want to Go: • Introducing 3 additional quality measures • Presenting select NCQA – PCMH elements • Planning for Behavioral Health • Participating with evaluation efforts (State, National) • Sending and receiving data through your EMR or CHIPRA Data Registry • Receiving quality reports • On-site visits (peer, Dr. Rushton, QTIP staff and SCORxE)