ABCD for Oregon’s Healthy Kids Oregon Division of Medical Assistance Programs
ABCD and Oregon
Medicaid Managed Care Organizations (MCOs) care for nearly 1 in 3 Oregon children.
Use a project that mirrors a Performance Improvement Project (PIP) to leverage Medicaid’s Managed Care requirements.
Implement a process of community engagement in order to guide and inform the development of the PIP .
One of the Optional EQRO Activities available to states (at 75% FFP)
Validate encounter data
Administer consumer & provider surveys
Validate consumer & provider surveys
Calculate of performance measures
Conduct of performance improvement projects
Conduct of focused studies on quality
Using CMS protocols as a road map
EQR must be conducted in a manner “consistent with” the protocols.
FFP at the 75 percent rate is available for expenditures for EQR activities
Find them at https://www.cms.gov/MedicaidCHIPQualPrac/07_Tools_Tips_and_Protocols.asp
The protocols are generic – latitude to customize to meet the goals of ABCD and your state.
You provide the tools to managed care
Makes it easier to join your efforts
Get more details from CFR 42 § 438.310 - .370.
10 Activities in the CMS PIP protocol
1. Select the study topic(s)
Define the study question(s)
Select the study indicator(s)
Use a representative and generalizable study population
Use sound sampling techniques (if sampling is used)
Reliably collect data
Implement intervention and improvement strategies
Analyze data and interpret study results
Plan for “real” improvement
Achieve sustained improvement
Oregon’s Activities and Interventions
Community engagement to help shape PIP
Parents (Community Cafés)
PCPs, EI staff, other stakeholders (interviews)
All of the above (town hall forum)
Learning collaboratives and quality improvement liaisons for managed care organizations (MCOs) to support PIP roll-out
MCO baseline assessment tool to capture current practices, guidelines to providers
Common referral form
Implications: Learning from doing
Really connecting systems is > connecting data, = people communicating
Being patient centered means doing the reality check of parent and families- cafés provide that forum
We are rebuilding our health care delivery system, first for Medicaid, then for public employees. The cafés help us understand the experience of getting care, what are parents’ expectations from a community perspective, and they do vary
We are building into the redesigned organizations a primary emphasis on care coordination (e.g., Operationalizing CPT codes 99366-99368)
We are rethinking early education as well
Oregon ABCD III Improvement Project www. oregon . gov/DHS/ph/ch/abcd . shtml Division of Medical Assistance Programs Charles Gallia, Ph.D. [email_address] SPECIAL THANK to Colleen Reuland, CAHMI and OPIP and Sarah Wetherson