chipra quality demonstration grant: quality through technology and innovation
DESCRIPTION
Demonstration of using technology and innovation in pediatricsTRANSCRIPT
CHIPRA Quality Demonstration Grant:
Felicity Myers, Ph.D.
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Stating the Obvious…
Stereotypes . . . Some are trueOregon:
legalized physician assisted suicidelegalized medical marijuanaCigarette tax is $1.18Obama 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 data
SimilaritiesPrevalence of binge drinkingLack of health insurancePrenatal care
DifferencesSouth Carolina has a higher percentage of immunizations, but Oregon does far better in most health indicatorsSouth Carolina has two times the expenditures on public health; however, Oregon has better outcomes. (SC is ranked 46th and Oregon ranked 13th)
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South Carolina’s Medicaid Program
A Conservative program only recently added children from 150-200% FPLlimited 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.
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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
SCDHHSAmerican Academy of Pediatrics (AAP)Family ConnectionsFederation of FamiliesDepartment 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
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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
QUALITYPursuit 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
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Focus of SC Grant
TECHNOLOGYproviding 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. 17
Focus of SC Grant
PEDIATRICSSelection of pediatric practices of a heterogeneousmix Working with the pediatric practices on becoming a NCQA medical homeExpanding the mental health services available in a pediatric settingEstablishing 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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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 feedbackPeer 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. 22
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 Information
Felicity Myers, Ph.D., Deputy [email protected]
Lynn Martin, QTIP Project [email protected]
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