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Transcript

  • 1. ABCD for Oregon’s Healthy Kids Oregon Division of Medical Assistance Programs
  • 2. 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 .
  • 3. 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
  • 4. 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.
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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