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Pediatric Performance Measurement: Florida's Experiences with CHIPRA

Pediatric Performance Measurement: Florida's Experiences with CHIPRA . External Quality Review Quarterly Meeting May 22, 2013 Caprice Knapp, PhD. Quality of Care in Pediatrics. 2011 IOM report “ Child Health and Child Health Outcomes ”

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Pediatric Performance Measurement: Florida's Experiences with CHIPRA

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  1. Pediatric Performance Measurement: Florida's Experiences with CHIPRA External Quality Review Quarterly Meeting May 22, 2013 Caprice Knapp, PhD

  2. Quality of Care in Pediatrics • 2011 IOM report “Child Health and Child Health Outcomes” • Health care expenditures are high (17% GDP), & outcomes are sub-par (Infant Mortality, Preventive Care) • Quality for the past 30 years has been primarily focused on adult and inpatient measures

  3. Child Health Quality is Finally in the Spotlight! • ACA • National Quality Strategy • Medicaid Pediatric Rate Increase • CHIPRA - 24 core pediatric measures • Reauthorization of CHIP - increased reporting • Each increases accountability, reporting, and places an emphasis on quality measures • Expect more emphasis on reporting and quality improvement in the future (MOC, etc)

  4. Children’s Health Insurance Program Reauthorization Act (CHIPRA)

  5. Goals of CHIPRA • Development of a core set of measures • Creation of new measures • Create an EHR format for children • Provider-based initiatives (stay tuned….) • Authorization of $20M to the Census Bureau to improve child-specific population estimates • Streamline enrollment

  6. 24 Core CHIPRA Measures • Measure selection process • Stakeholders: NQF, NCQA, AAP, AHRQ, NICHQ, etc. • Based on administrative, hybrid, registry, and survey data • Benchmarks do not exist • 18 states are participating in Part A • Noticeable gaps- mental health, substance abuse, end of life, disparities • In 2011, Florida reported on 20/24 • In 2012, Florida reported on 22/24

  7. Data Sources for measure calculation – 2012

  8. 2012 Dashboard

  9. Potential Measures for Improvement Measures Areas Preventive dental services Dental Care Dental treatments Ambulatory Care Emergency department visits Developmental Screening Development screening in the first 3 years of life Immunizations Childhood Immunization Status (CIS) Combo 3 Frequency of on going prenatal care (FPC) Prenatal Care Timeliness of prenatal care (PPC)

  10. HEDIS Administrative Measures 2012

  11. HEDIS Administrative Measures • Florida Met • Children and Adolescents’ Access to Primary Care Practitioners: Members 12 months to 25 months of age (CAP) • Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Continuation and Maintenance Phase • Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Initiation Phase • Florida Did Not Meet • Chlamydia Screening (CHL) • Children and Adolescents’ Access to Primary Care Practitioners: Members 25 months to 6 years of age (CAP) • Children and Adolescents’ Access to Primary Care Practitioners: Members 7 to 11years of age (CAP) • Children and Adolescents’ Access to Primary Care Practitioners: Members 12 to 19 years of age (CAP) • Follow-Up After Hospitalization for Mental Illness (FUH) • Appropriate Testing for Children With Pharyngitis (CWP) • Ambulatory Care: Emergency Department Visits (AMB)

  12. Appropriate Testing for Children With Pharyngitis (CWP): by Program Type 3.4% 3.3% 6.2% 7.0% 6.6% 4.8%

  13. Follow-Up Care for Children Prescribed ADHD Medication (ADD)- Initiation Phase by Program 11.1% 4.9% 3.6% 11.2%

  14. Follow-Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance Phase by Program 13.5% 5.9% 18.1%

  15. Non-HEDIS Administrative Measures 2012

  16. Non-HEDIS Administrative Measures • These Measures Include: • Total Eligibles Who Received Preventive Dental Services • Total Eligibles Who Received Dental Treatment Services • Annual Number of Asthma Patients with ≥ 1 Asthma-Related Emergency Room Visit

  17. Number of Asthma Patients with ≥1 Asthma-Related Emergency Room Visit: by Program Type 0.9% 0.3% 0.3% 0.8% 0.1%

  18. Optional Hybrid Measures 2012

  19. Optional Hybrid Measures • Florida Did Meet: • Well-Child Visits in the First 15 Months of Life (W15) • Florida Did Not Meet: • Prenatal and Postpartum Care: Timeliness of Prenatal Care (PPC) • Frequency of Ongoing Prenatal Care (FPC) • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents: Body Mass Index for Children/Adolescents (WCC) • Well-Child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34) • Adolescent Well-Care Visits (AWC)

  20. Well-Child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34) by Program 0.2% 0.3% 1.3% 0.9% 0.3%

  21. Adolescent Well-Care Visits (AWC) by Program 1.8% 1.3% 3.5% 0.7%

  22. Registry Measures 2012

  23. Registry Measures • These Measures Include: • Percentage of Live Births Weighing Less than 2,500 grams • Cesarean Rate for Nulliparous Singleton Vertex • Childhood Immunization Status (CIS)* • Immunization for Adolescents (IMA)* *Discussed on slide “What’s New in 2012?”

  24. Consumer Assessment of Healthcare Providers and Systems (CAHPS) 2012

  25. Composites that Florida Has Met National Benchmarks • How Well Child’s Doctor Communicates • Customer Service • Getting Needed Information • Overall Ratings for Child’s Personal Doctor • Overall Ratings for Child’s Specialist • Overall Ratings for Child’s Health Care • Overall Ratings for Child’s Health Plan

  26. Composites that Florida Has NOT Met National Benchmarks • Getting Needed Care • Getting Care Quickly • Shared Decision Making • Getting Specialized Services • Coordination of Care and Services • Personal Doctor Who Knows Child • Getting Prescription Medicine

  27. What was New in 2012? • Improvements in the registry measures • Using FL SHOTS data greatly increased compliance for all three Immunizations for Adolescents submeasures for FHKC enrollees.

  28. Hybrid Measure Annual Pediatric Hemoglobin (HbA1c) Testing and Control • Comparison of results of administrative and hybrid method

  29. What’s new in 2013? • Three new quality measures • Human Papillomavirus (HPV) Vaccine for Female Adolescents • Medication Management for People with Asthma • Behavioral Health Risk Assessment for Pregnant Women* • Two retired measures • Otitis Media with Effusion – Avoidance of Inappropriate Systemic Antimicrobials in Children • CLASBI • Florida will report 24/25 measures

  30. Summary • Quality measurement is here to stay • Measurement is not enough, the last 2 years of the CHIPRA grant will begin to focus on dissemination of information and ultimately, improvement. What you do for Medicaid and CHIP enrollees matters!

  31. Those who say it cannot be done should not interrupt the person doing it. -Chinese Proverb

  32. Contact Information: The Institute for Child Health Policy at the University of Florida www. ichp.ufl.edu Caprice Knapp, PhD caprice1@ufl.edu

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