CHIPRA Quality Demonstration Grant and Pennsylvania’s Early Intervention Strategies

1. CHIPRA Quality Demonstration Grant and Pennsylvania’s Early Intervention Strategies David Kelley MD, MPH Chief Medical Officer Office of Medical Assistance Programs 1

2. Pennsylvania’s CHIPRA Grant • Category B • Creation of Electronic Screening Tools • The objective is to leverage HIT to maximize the early identification of children with the following medical conditions: • Developmental delay • Autism • ADHD, disruptive behavior, anxiety, and sadness in school-age children • Depression/suicide risk in adolescents • Maternal depression • Patients/families complete web-based assessments prior to their clinic visit • Assessments can be completed at home or in the clinic waiting room • Once the web-based assessment is complete, it is electronically scored and loaded into the patient’s EHR • CHOP and Geisinger to implement the screening tools at a combined total of 22 practice sites by 2013 2

3. Pennsylvania’s CHIPRA Grant • Category B • Status of Electronic Screening Tools – no restriction based on payor • CHOP • Postpartum Depression (Edinburgh PD Scale) at 2 month WCV: 869 women screened, 15% (129) positive • Developmental Delay (ASQ) at 9, 18, 24, 30 month WCVs: 3009 children screened, 17% (512) failed • Autism (M-CHAT) at 18 and 24 month WCVs: 1727 children screened, 10% (173) failed the initial screening • Of these 173 children, 57% had M-CHAT Follow-Up questions documented • Geisinger • Developmental Delay (PEDS) at 9, 18, 24, 30 month WCVs: 172 children screened, 31% (54) failed • Autism (M-CHAT) at 18 and 24 month WCVs: 88 children screened, 5% (5) failed • Children with Special Health Care Needs – projects in development • This portion of the grant focuses on coordination of care efforts for children with complex medical conditions by addressing continuity of care, medication management and care plan management 3

4. Pennsylvania’s CHIPRA Grant • Category B • Children with Special Health Care Needs • CHOP – Focus on transition of care from hospital to home • Geisinger – Focus on management/care coordination of children with hypertension • An electronic referral system will be developed which allows patients to be electronically referred with care plan feedback to the PCP/EHR • Early Intervention • The CHIPRA grant plans to electronically link providers to DPW’s Office of Child Development and Early Learning’s web-based Pennsylvania’s Enterprise to Link Information Across Networks (PELICAN) Early Intervention (EI) system • PELICAN enables child serving social agencies, the education system and parents to develop and view care plans for children needing EI services • By bringing the medical providers into this community they will be able to participate in care plan development, share clinical information via PELICAN and the EHR, and have bi-directional communication with families and therapists 4

5. Pennsylvania’s Early Intervention Strategies • Pennsylvania’s Early Intervention Strategies • Provide validated screening and diagnostic assessment to identify developmental delay, autism and social-emotional problems • Provide infants, toddlers and their families access to preventive, early intervention, and treatment services for those experiencing or at risk of social-emotional problems • Have mechanisms in place to track referrals, such as shared data bases, which track the enrollment of children into EI • Assist efforts to build infrastructure to support an array of early intervention services and to track the movement/progression of children once enrolled in EI 5

6. Pennsylvania’s Early Intervention Strategies • The Future: Utilization of the Health Information Exchange • Health Information Exchange Strategy • Utilize HIE to improve the referral process • Allow HIE to assist in “closing the loop” from referral tracking to care coordination • HIE offers the benefit of open communication between EI and physicians and the wider availability of care plans • Federal Level Health Information Exchange • DIRECT - secure email exchange that is a component of the Nationwide Health Information Network Strategy • Leverage DIRECT to enable EI and medical providers to exchange care plans and other medical data • Bring PELICAN to this externally facing HIE • Broad Statewide Strategy • MA plans will measure rates for Developmental screening in the first three years of life for HEDIS 2013/CY 2012 • Focus on HIE to enable the plans to measure the developmental screening quality measure and to focus on “closing the loop” 6