strategic directions: key informant interviews with epsdt directors peggy mcmanus mch policy...
TRANSCRIPT
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 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 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: 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 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
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: 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: Interviews
Families:
-- 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: 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: 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: 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: 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: 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 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 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: 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: 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 “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: 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: 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 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 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: 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 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 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: 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: 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