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  1. 1. ABCD for Oregon’s Healthy Kids Oregon Division of Medical Assistance Programs
  2. 2. ABCD and Oregon <ul><li>Medicaid Managed Care Organizations (MCOs) care for nearly 1 in 3 Oregon children. </li></ul><ul><li>Use a project that mirrors a Performance Improvement Project (PIP) to leverage Medicaid’s Managed Care requirements. </li></ul><ul><li>Implement a process of community engagement in order to guide and inform the development of the PIP . </li></ul>
  3. 3. One of the Optional EQRO Activities available to states (at 75% FFP) <ul><li>Validate encounter data </li></ul><ul><li>Administer consumer & provider surveys </li></ul><ul><li>Validate consumer & provider surveys </li></ul><ul><li>Calculate of performance measures </li></ul><ul><li>Conduct of performance improvement projects </li></ul><ul><li>Conduct of focused studies on quality </li></ul>
  4. 4. Using CMS protocols as a road map <ul><li>EQR must be conducted in a manner “consistent with” the protocols. </li></ul><ul><li>FFP at the 75 percent rate is available for expenditures for EQR activities </li></ul><ul><li>Find them at https://www.cms.gov/MedicaidCHIPQualPrac/07_Tools_Tips_and_Protocols.asp </li></ul><ul><li>The protocols are generic – latitude to customize to meet the goals of ABCD and your state. </li></ul><ul><ul><li>You provide the tools to managed care </li></ul></ul><ul><ul><li>Makes it easier to join your efforts </li></ul></ul><ul><li>Get more details from CFR 42 § 438.310 - .370. </li></ul>
  5. 5. 10 Activities in the CMS PIP protocol <ul><li>1. Select the study topic(s) </li></ul><ul><li>Define the study question(s) </li></ul><ul><li>Select the study indicator(s) </li></ul><ul><li>Use a representative and generalizable study population </li></ul><ul><li>Use sound sampling techniques (if sampling is used) </li></ul><ul><li>Reliably collect data </li></ul><ul><li>Implement intervention and improvement strategies </li></ul><ul><li>Analyze data and interpret study results </li></ul><ul><li>Plan for “real” improvement </li></ul><ul><li>Achieve sustained improvement </li></ul>
  6. 6. Oregon’s Activities and Interventions <ul><li>Community engagement to help shape PIP </li></ul><ul><ul><li>Parents (Community Cafés) </li></ul></ul><ul><ul><li>PCPs, EI staff, other stakeholders (interviews) </li></ul></ul><ul><ul><li>All of the above (town hall forum) </li></ul></ul><ul><li>Learning collaboratives and quality improvement liaisons for managed care organizations (MCOs) to support PIP roll-out </li></ul><ul><li>MCO baseline assessment tool to capture current practices, guidelines to providers </li></ul><ul><li>Common referral form </li></ul>
  7. 7. Implications: Learning from doing <ul><li>Really connecting systems is > connecting data, = people communicating </li></ul><ul><li>Being patient centered means doing the reality check of parent and families- cafés provide that forum </li></ul><ul><li>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 </li></ul><ul><li>We are building into the redesigned organizations a primary emphasis on care coordination (e.g., Operationalizing CPT codes 99366-99368) </li></ul><ul><li>We are rethinking early education as well </li></ul>
  8. 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