CHIPRA Quality Demonstration Grant:

Felicity Myers, Ph.D.

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Stating the Obvious…

Stereotypes . . . Some are trueOregon:

legalized physician assisted suicide legalized medical marijuana Cigarette tax is $1.18 Obama received 57% of the vote in 2008 election.

South Carolina: “Second Amendment Weekend” (aka tax free

guns) Cigarette tax increased from $.07 to $.57 in July

2010, Most mobile homes per capita “Buckle of the Bible Belt” Obama received 45% of the vote in 2008 election

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However, there are some surprising similarities

between the states… Roughly the same tax burden per

capita

Roughly the same voting populace

Both have among the highest rates of unemployment

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Comparing the states on health dataSimilarities

Prevalence of binge drinking Lack of health insurance Prenatal care

Differences South Carolina has a higher percentage of

immunizations, but Oregon does far better in most health indicators

South Carolina has two times the expenditures on public health; however, Oregon has better outcomes. (SC is ranked 46th and Oregon ranked 13th) 5

South Carolina’s Medicaid Program A Conservative program

only recently added children from 150-200% FPL

limited array of optional services limited outreach

Medicaid and CHIP are administered within the same agency.

Some services are predominately provided by public providers.

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South Carolina’s Medicaid Program is…

Facing challenges: Relationships are strained with

most provider and advocacy groups at this time.

Under numerous legislative constraints.

Facing a significant shortfall in FY11. 7

QTIP

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Quality through Technology and Innovations in Pediatrics

Administered through the South Carolina Health and Human Services

$9,2 77,361 grant award

The project represents a unique opportunity for South Carolina pediatricians to help develop quality improvement tools that will lead to better health outcomes for current and future generations of patients

Impetus Behind Grant

SCAAP chapter saw this grant as a mechanism for strengthening their promotion of the PCMH model in pediatric practices.

Our director saw this grant as an opportunity to “jumpstart” the HIT efforts.

I saw this as a platform to expand integration of behavioral health into the primary care setting and to test what supports/elements are necessary for making integration successful.

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What Did South Carolina Propose?• to demonstrate the ability to build a

provider friendly continuous closed-loop, quality improvement infrastructure focused on pediatric primary care practices.

• to use the State’s existing health information exchange (HIE) infrastructure, to help participating pediatric practitioners “connect” to other providers to better deliver coordinated care.

• to work with providers to implement the patient-centered medical home (PCMH) model and the integration of mental health services.

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South Carolina Chose Categories:

Category A – Experiment with, and evaluate the use of, new measures for quality of Medicaid/ CHIP children’s health care

Category B – Promote the use of Health Information Technology for the delivery of care for children covered by Medicaid/CHIP

Category C – Evaluate provider-based models which improve the delivery of Medicaid/CHIP children’s health care services

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South Carolina’s Medicaid Program

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DHHS strengths which will enhance implementation of the CHIPRA grant are:

Reimbursement for pediatric subspecialists and for dentists have greatly improved access to care.

Existing relationships (AAP, USC, Thomson Reuters, CareEvolution)

Existing framework for HIE

DHHS Director is also the State HIE leader.

Grant Partners SCDHHS American Academy of Pediatrics (AAP) Family Connections Federation of Families Department of Health and Environmental Control

(DHEC) Department of Mental Health (DMH) South Carolina Primary Health Care Association

(SCPHCA) Thomson Reuters Institute for Families in Society (IFS) South Carolina Offering Prescribing Excellence

(SCORxE) Care Evolution 13

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.

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Focus of SC Grant

QUALITY Pursuit of National Committee for Quality

Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification by all participating practices.

Collection of CHIPRA Quality Measures.

Utilization of Learning Collaboratives and the Plan, Do,

Study, Act quality improvement cycle 15

Focus of SC Grant

TECHNOLOGY providing primary care physicians with

HIT tools that will allow them to track their patients outcomes

Technology and the generated reports will allow the practices to compare their performance to others.

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Focus of SC Grant

INNOVATION Providing behavioral health tools to

primary care physicians (such as standardized mental health screening tools, academic detailing, and coordination with mental health providers).

Increasing linkage of family support organizations such as Family Connections and Federation of Families with practices to provide additional resources.

Statewide Learning Collaboratives integrate and support all QTIP initiatives.

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Focus of SC Grant

PEDIATRICS Selection of pediatric practices of a

heterogeneous mix Working with the pediatric practices on

becoming a NCQA medical home Expanding the mental health services

available in a pediatric setting Establishing a quality improvement

team within the pediatric setting to implement and review quality measures.

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The patient is the focus

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Patient

PCMH model supports the patient and family

Grant provides additional supports for physicians

How HIT pieces all ties together

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Provider sees patients

Provider enters data into EMR or

EMR-Lite

Data travels fromSCHIEx to

Decision SupportSystem

Clinical data is merged

with claims data

Provider receives quality report

feedback

CATCH Learning Collaborative

Peer to peer review

Quality improvement strategies

Practice/provider makes adjustments

Improved and informed patient care

Quality reports are generated

PDSA Cycle

Progress to Date Staff have been hired and contracts

finalized with our principal contractors.

Planning & Steering Committee (PSC) has been established and meeting since April 2010

Physician based Learning Collaborative Expert Committee chosen

18 practices (who meet criteria established by the PSC) have been selected .

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Progress to Date

HIT gap analyses has started

A conference which focuses on the PCMH model and behavioral health integration is planned for October 2010.

Our first Learning Collaborative focused in CHIPRA Quality Indicators will be held in January.

We have tested the data-mining and reporting process in one site.

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Challenges

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1. Scope: SC is trying to tie a lot of components together in this grant. • While this creates layers of support

and is ultimately anticipated to result in improved quality of care to pediatric patients, this creates issues with evaluation. “Which components contributed to improvements in care?”

2. Ever changing needs – Planning vs. Reality:• Budget changes• Competing interests

Challenges

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3. Bureaucracy• Within SC• Competing Federal interest• Competing grants (overlap,

duplication, support, timelines)

4. Provider Selection• Although heterogeneity was an

intentional element in provider selection, this brings challenges with mental health integration, HIT and community resources and supports.

• Working within existing systems

Challenges

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5. “Assistance” versus “Burden” to the pediatric practices• Too many “helpers”• Time with patients• Comfort level with technology • Advantages of QI not obvious to the

average practitioner• Not accustomed to working in practice

teams

6. Big Personalities and Opinions

Contact InformationFelicity Myers, Ph.D., Deputy Directormyersfc@scdhhs.gov803-898-2803

Lynn Martin, QTIP Project Directormartinly@scdhhs.gov803-898-0093

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