Improve EPSDT Service Quality Through Meaningful Use of IT

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Improve EPSDT Service Quality Through Meaningful Use of IT

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The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. A legal......

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. A legal standard of coverage and access for low-income children. EPSDT has remained a central component of Medicaid, because of the operational and financial capacity it gives states to create appropriate pediatric health care systems (its ability to finance early, preventive, and on going healthcare for children at medical and social risk remains unparalleled in public or private health insurance). This paper provides an ntroduction to EPSDT, an overview of current EPSDT service and quality monitoring, and how EPSDT can be better supported through Meaningful Use of health IT.

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  • 1. Improve EPSDT Service Quality Through Meaningful Use of HIT Xiaohui Zhang, Ph.D., Chief Scientist & Technology Strategist, STC Mark Shishida, Executive Vice President, Cognosante Seonho Kim, Chief Architect, ApeniMed, Inc. Presented at: Medicaid Enterprise Systems Conference 2012, Boston, MAThis white paper contains data that shall not be duplicated, used, or disclosed in whole or in part without the express permission of Cognosante. Copyright© 2012.
  • 2. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012 ContentsWHO WE ARE AND WHAT WE DO .............................................................................................................. 1HIGHLIGHT OF THE PRESENTATION .......................................................................................................... 1EPSDT – THE PEDIATRIC COMPONENT IN MEDICAID ............................................................................. 1HEALTH CARE BENEFITS ................................................................................................................................ 2STATE ADMINISTRATIVE SUPPORT SERVICES ................................................................................................... 2CHALLENGES IN EPSDT MANAGEMENT AND DATA MONITORING......................................................... 2EPSDT DENTAL PERIODICITY SCHEDULES BY STATES – SOME STILL NOT AVAILABLE ..................................... 3SUMMARY OF MEDICAID ENROLLMENT CHANGE 2000 – 2011 ........................................................................ 42011: MEDICAID AND CHIP ENROLLMENT CHILDREN IS ABOUT 83% OF TOTAL MEDICAID ENROLLMENT ..... 5CURRENT EPSDT DATA MONITORING AND CHALLENGES ...................................................................... 6AN ILLUSTRATION OF CURRENT EPSDT DATA MONITORING BY ANNUAL REPORT FORM-416 .............................. 7DISCONNECTIONS IN THE CURRENT MEASUREMENTS ............................................................................. 7A CLOSE LOOK AT THE LATEST NATIONAL EPSDT REPORT DATA ....................................... 1SUPPORT EPSDT IN ERA OF MEANINGFUL USE OF HIT .............................................................. 6SOME QUESTIONS WE HAVE BEEN ASKING .............................................................................................. 1LEVERAGE THE MU OF HIT AND CHIPRA AND OTHER INITIATIVES..................................................... 2EXAMPLE OF LEVERAGE HEALTHDATA.GOV FOR (MEASURE-3) PERCENTAGE OF LIVE BIRTH WEIGHTING LESS THAN 2500 GRAMS ................................................................................................................................... 3EASY TO QUERY, EXPORT DATA AND BETTER SUPPORT MEDICAID MANAGEMENT .......................................... 4EXAMPLE – CHILDHOOD IMMUNIZATION STATUS (MEASURE 5) ............................................................ 4EXAMPLE : CHILDHOOD IMMUNIZATION STATUS REPORT ..................................................................... 5THE CONCLUSION AND DISCUSSIONS ......................................................................................................... 7 Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. ii
  • 3. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012WHO WE ARE AND WHAT WE DO Scientific Technologies Corp. (STC) Leading PH IT solutions in 24 years, supporting 16 states immunization registries with 700+ HL7 links, 17,000+ providers, 24 M patients STC has supported disease surveillance in 10 states, NYC and WDC Cognosante Healthcare IT company serving more than 40 Medicaid, EPSDT and CHIP programs for over 25 years Expert in Health Information Exchange, assisting ONC with CONNECT architecture & standards ApeniMED Provides clinical networking interoperability solutions An industry-leader in HIE and federal agency connectivity using the NwHINHIGHLIGHT OF THE PRESENTATION Introduction to EPSDT and a snapshot of its beneficiaries Current EPSDT service and quality monitoring The major challenges and the gaps Better support EPSDT with the initiatives in MU of HIT The historical opportunity for EPSDT in ARRA/HITECH with EMRs, EDRs, PHRs and HIE efforts “Healthdata.gov “and initiatives Improve EPSDT delivery through leveraging the Core Set of Children’s Healthcare Quality Measures Examples of integrated EPSDT management tool in new quality measuresEPSDT – THE PEDIATRIC COMPONENT IN MEDICAID The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. A legal standard of coverage and access for low-income children EPSDT has remained a central component of Medicaid, because of the operational and financial capacity it gives states to create appropriate pediatric health care systems (its ability to finance early, preventive, and on going healthcare for children at medical and social risk remains unparalleled in public or private health insurance). Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 1
  • 4. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012Health Care Benefits Periodic assessments of children’s growth and development in accordance with accepted pediatric assessment standards, including: Unclothed physical exam incuding a nutritional assessment; An assessment to determine a child’s overall physical, mental, and developmental health (the developmental assessment); Health history; Laboratory services as needed, including assessment of blood lead levels; Immunizations in accordance with the recommendations of the Advisory Committee on the Immunization Practices; and Anticipatory guidance. Interperiodic (as needed) assessments. Comprehensive vision, dental, and hearing services in accordance with reasonable professional standards. All medically necessary dagnostic and treatment items and services that fall within the definition of medical assistance. A preventive standard of medical necessity that specifies “early” coverage to “correct or ameliorate” physical and mental conditions in children. Coordination with related programs.State Administrative Support Services Information about EPSDT and the value of preventive health care. Provision of scheduling and transportation to families who request services in order to ensure the timely provision of care. Provision of reports to the United States Department of Health and Human Services regarding the number of children referred for corrective treatment, and the state’s results in attaining federally set participation goals. —From EPSDT at 40 by CHCSCHALLENGES IN EPSDT MANAGEMENT AND DATA MONITORING State varying well-child visiting periodicity schedules and the visit documentation forms Most states follow AAP Bright Future for age groups in 0-11 months, 1-4 years, 5-10 years old Age 12-21 years old 36 states require annual preventive visit 12 states require a visit every two years One state requires a visit every four years States use different forms State varying separated dental visiting periodicity schedules Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 2
  • 5. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012EPSDT Dental Periodicity Schedules by States – Some Still not Available American Academy of Pediatric Dentistry Website 8-10-2012 Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 3
  • 6. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012Summary of Medicaid Enrollment Change 2000 – 2011 From Kaiser Commission of Medicaid Facts: Medicaid Enrollment June 2011 Data Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 4
  • 7. Improve EPSDT Service Quality through Meaningful Use of HIT August 20122011: Medicaid and CHIP Enrollment Children is about 83% of Total Medicaid Enrollment Reference: 2011 CHPRA Annual Report Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 5
  • 8. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012CURRENT EPSDT DATA MONITORING AND CHALLENGES State Medicaid agencies are required to report annually on EPSDT services (CMS Form-416) The annual report provides basic information for weather the care is received by age groups and basis of Medicaid eligibility The number of children eligible 90 continuous days (new) The number of beneficiaries who receive Medical screens / dental screens The number receive diagnostic or treatment services The number of referred for corrective treatment services. The data in current EPSDT measures Claim based Paper based Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 6
  • 9. Improve EPSDT Service Quality through Meaningful Use of HIT August 2012 Participant ratio and screen ratio Little about the content of careAn illustration of current epsdt data monitoring by annual report form-416DISCONNECTIONS IN THE CURRENT MEASUREMENTS Service quality measurement Service completeness Examples of FORMs (content of care at dif ages) Service availability Outreach (identify and enroll children eligible for Medicaid / CHIP) Make the service available for the eligible children Population health outcomes Children at risks Chronic conditions Mental health issues Referrals and follow up treatment Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 7
  • 10. Improve EPSDT Service Quality through Meaningful Use of HIT DateA CLOSE LOOK AT THE LATEST NATIONAL EPSDT REPORT DATA Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 1
  • 11. Improve EPSDT Service Quality through Meaningful Use of HIT DateUse or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 2
  • 12. Improve EPSDT Service Quality through Meaningful Use of HIT DateUse or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 3
  • 13. Improve EPSDT Service Quality through Meaningful Use of HIT DateUse or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 4
  • 14. Improve EPSDT Service Quality through Meaningful Use of HIT DateUse or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 5
  • 15. Improve EPSDT Service Quality through Meaningful Use of HIT DateSUPPORT EPSDT IN ERA OF MEANINGFUL USE OF HIT Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 6
  • 16. Improve EPSDT Service Quality through Meaningful Use of HIT DateSOME QUESTIONS WE HAVE BEEN ASKING How to improve the EPSDT service quality Improve the service availability, accessibility and service quality Improve the EPSDT management efficiency and lower the cost (such as the coordinated integrated eligibility and enrollment systems for Medicaid, CHIP and HIX) How to help providers improve performance Improve the service efficiency by leveraging e-data and HIE, such as EMR data and EDR data Improve the service completeness by clinical support systems with EPSDT workflow How to improve the Medicaid children health outcomes through the new initiatives How to leverage the chart review data captured in EPSDT visiting to Identify the population health issues How to better support the early preventive healthcare How to construct the coordinated and integrated EPSDT service systems by leveraging the new initiatives Better support the continuous care through the HIE effort Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 1
  • 17. Improve EPSDT Service Quality through Meaningful Use of HIT DateLEVERAGE THE MU OF HIT AND CHIPRA AND OTHER INITIATIVES ARRA/HITECH – historical opportunities for improving EPSDT Rapidly adopted EMRs and extensive HIE efforts Lower volume thresholds for M.U. payments to Medicaid pediatricians (20% of Medicaid patient volume) Leadership at Federal Level New policy and new funding – CHIPRA quality measures HIT impact on care for children Goals Improve the EPSDT delivery and service quality through integrating CHIPRA and ARRA Improve the Medicaid children health outcomes Selected Examples with Illustrated Approaches Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 2
  • 18. Improve EPSDT Service Quality through Meaningful Use of HIT Date Improve outreach and enrolling all eligible individuals by healthdata.gov Improve EPSDT service quality by leveraging Initial Core Set of Health Care Quality Measures for Children in Medicaid and CHIP Develop a high performance info system that integrates with Enterprise Medicaid, HIE and HIX, as well as EMRsExample of Leverage Healthdata.gov for (Measure-3) Percentage of Live Birth Weighting less than 2500 grams Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 3
  • 19. Improve EPSDT Service Quality through Meaningful Use of HIT DateEasy to Query, Export Data and Better Support Medicaid ManagementEXAMPLE – CHILDHOOD IMMUNIZATION STATUS (MEASURE 5) Percentage of children that turned 2 years old during the measurement year and had specific vaccines (measured in rate of each of 10 vaccine and 9 combination) Continuous enrollment 12 months prior to the 2nd birthday, No more than one gap in enrollment of up to 45 days No more than a one-month gap if the enrollment varying monthly The denominator A systematic sample from the eligible population Exclusion: children have contraindication for a specific vaccine Data source: administrative or hybrid Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 4
  • 20. Improve EPSDT Service Quality through Meaningful Use of HIT DateEXAMPLE : CHILDHOOD IMMUNIZATION STATUS REPORT(Core Set Measure-5) Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 5
  • 21. Improve EPSDT Service Quality through Meaningful Use of HIT DateUse or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 6
  • 22. Improve EPSDT Service Quality through Meaningful Use of HIT DateTHE CONCLUSION AND DISCUSSIONS EPSDT has maintained as a central component in Medicaid The initiatives in MU of HIT and CHIPRA quality measures have provided tremendous opportunities for improving EPSDT delivery and service quality EPSDT should take advantage of rapidly adopted EMRs and HIE effort Develop EPSDT module in pediatric EMRs Improve patient safety Advance the standards of care Integrate EPSDT with HIE to support care coordination Share the data among pediatricians, PCP and dentists An integrated EPSDT information system in the state Medicaid management could help Outreach the eligible children to enroll EPSDT and receive the services Identify the Medicaid children population health risk early Better capture the provided care data and improve the quality providers improve performanceIn memory of Barbara Bridgewater for her passion, insight, courage and dedication to the Medicaidindustry.Barbara was the coauthor of the original abstract for this presentation.Thank You and Contact Information : Xiaohui Zhang, Ph.D., Chief Scientist & Technology Strategist,STC Xiaohui_zhang@stchome.com Mark Shishida, Executive Vice President, Cognosante Seonho Kim,Chief Architect, ApeniMed, Inc., Use or disclosure of data contained on this sheet is subject to the restriction on the title page of this white paper. 7