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STRATEGIC DIRECTIONS: Key Informant Interviews with EPSDT Directors. Peggy McManus MCH Policy Research Center July 12-13, 2005. STRATEGIC DIRECTIONS STANDARDS & POLICIES. Session Objectives: Examine state EPSDT policies for hearing screening & follow-up

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strategic directions key informant interviews with epsdt directors

STRATEGIC DIRECTIONS:Key Informant Interviews with EPSDT Directors

Peggy McManus

MCH Policy Research Center

July 12-13, 2005

strategic directions standards policies
  • Session Objectives:
    • Examine state EPSDT policies for hearing screening & follow-up
    • Compare with JCIH, AAP guidelines, & Healthy People 2010 objectives
    • Consider strategies for updating state EPSDT policies on hearing
interview findings current picture and strategies
Interview Findings: Current Picture and Strategies
  • EPSDT standards primarily based on AAP preventive care guidelines, with some variations
  • EPSDT standards on hearing focus almost exclusively on screening, not referral & follow-up
  • Unclear the extent to which EPSDT standards reflect JCIH guidelines
standards policies interviews
Standards & Policies: Interviews
  • States have organized mechanisms for regularly updating EPSDT, with input from other state agencies & key stakeholder groups
  • New standards & policies disseminated through provider manuals, bulletins, & newsletters
  • Effective ways of implementing new standards -- work closely with state AAP chapters
standards policies interviews5
Standards & Policies: Interviews
  • Less involvement with AAFP, though states interested in more
  • Hospital involvement critical
  • State universal newborn hearing screening laws – key in facilitating adoption of standards
  • Attention needed to address outreach, screening, & follow-up of failed screens.
strategic directions information education
Strategic Directions Information & Education
  • Session Objectives:
    • Share ideas about effective educational strategies for working with PCPs, families, hospitals, MCOs, and local health departments (LHDs)
    • Examine potential opportunities for informing & involving key stakeholders
information education interviews
Information & Education: Interviews

Primary Care Physicians:

  • No magic bullets or single approaches
  • Very little done so far on follow-up
  • Important to have good, actionable data about how PCPs perform
  • Evidence-based data also important
  • Newsletters that profile promising practices useful
information education interviews8
Information & Education: Interviews

PCPs continued:

  • Ongoing training of residents helps
  • CME necessary, but not sufficient
  • More needed to target PCPs in rural areas, with small numbers of children in practice
information education interviews9
Information & Education: Interviews


-- Work with existing family networks

-- More education is needed on follow-up, esp. with families whose children have complex health care needs

-- Follow-up telephone calls & face-to-face meetings work best

information education interviews10
Information & Education: Interviews
  • Use of popular media helpful
  • Critical to have a “why” piece – explaining why both screening & follow-up are necessary
  • Informing families about standard of care is important and can positively influence parent demand for services
information education interviews11
Information & Education: Interviews
  • Hospitals
    • State EHDI efforts, esp. involving on-site work, critical in implementing universal newborn hearing screening
    • Funding hearing aid loaner program important
    • Need to target small, rural hospitals and move beyond screening
    • Perinatal conferences important
    • Also, having short educational videos about hearing screening for use by hospitals important
information education interviews12
Information & Education: Interviews
  • Local Health Departments
    • EPSDT outreach workers have critical role to play, but few have focused on hearing
    • Important to link with home visiting, case management, disease mgmt., & other initiatives involving LHDs
    • Regular training opportunities for LHDs, with CME important
information education interviews13
Information & Education: Interviews
  • Hard-to-reach groups
    • EPSDT outreach workers have critical role to play
    • Home visiting & case mgmt. programs reach high-risk groups, though hearing follow-up seldom addressed
    • More attn. to cultural competence to reduce families’ delays in seeking follow-up
    • Translation & transportation are critical
information education interviews14
Information & Education: Interviews
  • Overarching Comments
    • Comprehensive strategy needed, promoted through various channels (e.g., immunization)
    • Have a simple, consistent message – 1/3/6
    • Involve key groups at outset
    • Address shortage of audiologists, incl. causes – education & training, reimbursement, other
    • Streamline & integrate hearing follow-up services with CM, EI, WIC, 1-800 #, EPSDT outreach, etc
strategic directions quality financial incentives
Strategic Directions: Quality & Financial Incentives
  • Session Objectives
    • Review potential opportunities for incorporating national benchmarks from Healthy People 2010
    • Examine Medicaid reimbursement levels for hearing services
    • Consider alternative performance incentive strategies
quality incentives interviews
Quality Incentives: Interviews
  • Few EPSDT programs use or are aware of Healthy People 2010 hearing objectives
  • Most Medicaid quality standards from NCQA (HEDIS), AAP
  • Use of quality indicators (e.g., 1/3/6) could be an effective strategy
  • Important to have actionable data for use by providers
  • Comparative state data also helpful
quality incentives interviews17
Quality Incentives: Interviews
  • NICHQ’s model of collaborating with practices, conducting chart reviews, identifying improvement strategies, & providing feedback (eg, lead, immuniz)
  • Need to make sure hearing screening & follow-up is incorporated into EPSDT evaluations. Records could be tagged for follow-up
quality incentives interviews18
Quality Incentives: Interviews
  • Consider a GPRA project (e.g., immunization)
  • CMS could set a standard (e.g., dental care)
  • Maintain close link with public health
  • Issue certificates of excellence to providers scoring 95% of higher
  • Acknowledge the good work of providers “They’re not doing this work for the financial rewards, but for the benefits to children.”
reimbursement incentives interviews
Reimbursement Incentives: Interviews
  • “Ha, ha, ha. Stand in line.”
  • State Medicaid and public health funding is already stretched to its limits
  • Important to piggyback with existing EPSDT administrative outreach efforts
  • Through Medicaid’s administrative match, possibly some potential for funding follow-up activities
reimbursement incentives interviews20
Reimbursement Incentives: Interviews
  • To claim administrative match requires financial support from other state agencies – good luck!
  • To justify payment changes, evidence of cost savings needed
  • Professional organizations & provider groups need to advocate for rate increases showing costs not being met and access adversely affected
reimbursement incentives interviews21
Reimbursement Incentives: Interviews
  • Also, comparative state fee data useful – no one wants to be lowest (see handouts)
  • See examples from dental care. Also, incentives used successfully with EPSDT visit rates, immunizations, & lead screening
  • Examine hospital payment mechanisms to assess where to place incentive
  • Consider outside foundation & community funds
strategic directions monitoring tracking
Strategic Directions: Monitoring & Tracking
  • Session Objectives
    • Examine existing state data sources and data-sharing arrangements to link with
    • Consider ways to improve accuracy & quality of reportable data on hearing screening & follow-up
monitoring tracking interviews
Monitoring & Tracking: Interviews
  • Accurate data depends on accurate provider coding. Providers/office staff may need training on appropriate coding.
  • When hearing services bundled into a single code or folded into DRG payments, difficult to rely on claims data
  • Tracking hearing is much more complicated than lead screening
monitoring tracking interviews24
Monitoring & Tracking: Interviews
  • Potential data sources: vital records, EPSDT, EHDI tracking system, early intervention, care management, hospital databases, administrative claims, case management systems, registries
  • Data-sharing agreements most helpful
  • Publish program success
strategic directions collaboration
Strategic Directions:Collaboration
  • Session Objectives
    • Identify new & existing opportunities to effectively promote collaboration among key stakeholders
    • Share information about promising strategies
    • Consider roles & responsibilities for state EHDI programs to play with Medicaid & participating MCOs and other providers
collaboration interviews
Collaboration: Interviews
  • Already a great deal of collaboration between Medicaid and EHDI programs, mostly around newborn screening
  • Meetings at least quarterly help, involving Medicaid & other key stakeholders
  • Written interagency agreements useful in promoting accountability
collaboration interviews27
Collaboration: Interviews
  • Examples: MD – a portion of EHDI coordinator’s time/salary is dedicated to working with Medicaid.
  • IL: “Think Tank Day” on newborn hearing projects for coming year; developed education, referral, & follow-up document; grand rounds training with AAP; newborn screening advisory group; now working on parent website
collaboration interviews28
Collaboration: Interviews
  • Linking with other screening programs, such as electronic birth certificates, immunizations, or newborn metabolic screening, may have potential but not yet done for most part
  • State Early Childhood Comprehensive Systems (SECCS) grants important vehicles to link with in many states. Other initiatives – Healthy Babies/Healthy Kids& Families, Commonwealth’s ABCD program, & Early Education and Care