Demonstration of using technology and innovation in pediatrics

1. CHIPRA Quality Demonstration
Grant:
Felicity Myers, Ph.D.

2. 2
Stating the Obvious…

3. Stereotypes . . . Some are true
Oregon:
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
3

4. 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
4

5. Comparing the states on health data
Similarities
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

6. 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.
6

7. 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

8. QTIP
8
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

9. 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.
9

10. 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. 10

11. 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
11

12. South Carolina’s Medicaid Program
12
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.

13. 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

14. 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.
14

15. 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

16. 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.
16

17. 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

18. 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.
18

19. The patient is the focus
19

20. How HIT pieces all ties together
20
Provider sees
patients
Provider enters
data into EMR
or EMR-Lite
Data travels from
SCHIEx to
Decision Support
System
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

21. 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 .
21

22. 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

23. Challenges
23
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

24. Challenges
24
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

25. Challenges
25
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

26. Contact Information
Felicity Myers, Ph.D., Deputy Director
myersfc@scdhhs.gov
803-898-2803
Lynn Martin, QTIP Project Director
martinly@scdhhs.gov
803-898-0093
Myers 26