ICHP and CHIPRA Requirements: Focus on Quality

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ICHP and CHIPRA Requirements: Focus on Quality
PEDIATRIC PERFORMANCE
MEASUREMENT: FLORIDA'S
EXPERIENCES WITH CHIPRA
External Quality Review Quarterly Meeting
May 22, 2013
Caprice Knapp, PhD
QUALITY OF CARE IN PEDIATRICS

2011 IOM report “Child Health and Child
Health Outcomes”

Health care expenditures are high (17%
GDP), & outcomes are sub-par (Infant
Mortality, Preventive Care)

Quality for the past 30 years has been
primarily focused on adult and inpatient
measures
CHILD HEALTH QUALITY IS FINALLY IN
THE SPOTLIGHT!

ACA
National Quality Strategy
 Medicaid Pediatric Rate Increase


CHIPRA - 24 core pediatric measures

Reauthorization of CHIP - increased reporting
• Each increases accountability, reporting, and places an
emphasis on quality measures
• Expect more emphasis on reporting and quality improvement in
the future (MOC, etc)
CHILDREN’S HEALTH INSURANCE
PROGRAM REAUTHORIZATION ACT
(CHIPRA)
GOALS OF CHIPRA

Development of a core set of measures

Creation of new measures

Create an EHR format for children

Provider-based initiatives (stay tuned….)
Authorization of $20M to the Census Bureau to improve
child-specific population estimates
 Streamline enrollment

24 CORE CHIPRA MEASURES

Measure selection process

Stakeholders: NQF, NCQA, AAP, AHRQ,
NICHQ, etc.

Based on administrative, hybrid, registry, and
survey data

Benchmarks do not exist

18 states are participating in Part A

Noticeable gaps- mental health, substance
abuse, end of life, disparities

In 2011, Florida reported on 20/24

In 2012, Florida reported on 22/24
DATA SOURCES FOR MEASURE
CALCULATION – 2012
2012 DASHBOARD
Prevention and Health Promotion
 There are 13 preventive and health promotion measures.
 As compared to national benchmarks, Florida’s performance
is strong and slightly below the benchmark.
Management of Acute Conditions
 There are three measures that assess management of acute
conditions.
 Florida has more room for improvement on these measures
as compared to the others.
Dashboard Key
Benchmark
Performance
Management of Chronic Conditions
 Of the three measures that assess the management of
chronic conditions, Florida has average performance that is
slightly below national benchmarks.
Family Expectations of Care
 Florida has the strongest performance in the family
expectations of care measures. Results are roughly equal to
the national benchmarks.
Dashboard Key
Benchmark
Performance
POTENTIAL MEASURES FOR IMPROVEMENT
Areas
Measures
Preventive dental services
Dental Care
Dental treatments
Ambulatory
Care
Emergency department visits
Developmental
Screening
Development screening in the
first 3 years of life
Immunizations
Prenatal
Care
Childhood Immunization Status
(CIS) Combo 3
Frequency of on going prenatal
care (FPC)
Timeliness of prenatal care
(PPC)
HEDIS ADMINISTRATIVE
MEASURES 2012
HEDIS ADMINISTRATIVE MEASURES

Florida Met
Children and Adolescents’ Access to Primary Care
Practitioners: Members 12 months to 25 months of age
(CAP)
 Follow-Up Care for Children Prescribed ADHD
Medication (ADD) – Continuation and Maintenance Phase
 Follow-Up Care for Children Prescribed ADHD
Medication (ADD) – Initiation Phase


Florida Did Not Meet







Chlamydia Screening (CHL)
Children and Adolescents’ Access to Primary Care
Practitioners: Members 25 months to 6 years of age
(CAP)
Children and Adolescents’ Access to Primary Care
Practitioners: Members 7 to 11years of age (CAP)
Children and Adolescents’ Access to Primary Care
Practitioners: Members 12 to 19 years of age (CAP)
Follow-Up After Hospitalization for Mental Illness (FUH)
Appropriate Testing for Children With Pharyngitis (CWP)
Ambulatory Care: Emergency Department Visits (AMB)
APPROPRIATE TESTING FOR CHILDREN WITH
PHARYNGITIS (CWP): BY PROGRAM TYPE
3.4%
3.3%
6.2%
7.0%
6.6%
4.8%
100%
80%
Benchmark: 65.5%
Rate
60%
40%
60.5%
20%
51.6%
55.5%
60.4%
TXIX FFS
TXIX PCCM
TXIX HP
66.3%
67.0%
TXXI MediKids
TXXI Healthy
Kids
0%
TXIX CMSN
Title XIX
Title XXI
FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD
MEDICATION (ADD)- INITIATION PHASE BY PROGRAM
11.1%
4.9%
3.6%
11.2%
100%
80%
Rate
60%
40%
Benchmark: 35.7%
20%
29.0%
36.8%
41.5%
36.6%
TXIX PCCM
TXIX HP
TXXI Healthy Kids
0%
TXIX FFS
Title XIX
Title XXI
FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD
MEDICATION (ADD): CONTINUATION AND MAINTENANCE
PHASE BY PROGRAM
13.5%
5.9%
18.1%
100%
80%
Rate
60%
Benchmark: 42.1%
40%
53.5%
20%
38.6%
27.7%
0%
TXIX FFS
TXIX HP
Title XIX
TXXI Healthy Kids
Title XXI
NON-HEDIS ADMINISTRATIVE
MEASURES 2012
NON-HEDIS ADMINISTRATIVE MEASURES

These Measures Include:

Total Eligibles Who Received Preventive
Dental Services

Total Eligibles Who Received Dental
Treatment Services

Annual Number of Asthma Patients
with ≥ 1 Asthma-Related Emergency
Room Visit
NUMBER OF ASTHMA PATIENTS WITH ≥1 ASTHMARELATED EMERGENCY ROOM VISIT: BY PROGRAM TYPE
0.9%
0.3%
0.3%
0.8%
0.1%
100%
80%
Rate
60%
40%
20%
0%
10.2%
13.9%
10.7%
TXIX CMSN
TXIX FFS
TXIX PCCM
Title XIX
9.6%
5.7%
TXXI MediKids TXXI Healthy Kids
Title XXI
OPTIONAL HYBRID MEASURES
2012
OPTIONAL HYBRID MEASURES

Florida Did Meet:


Well-Child Visits in the First 15 Months of Life
(W15)
Florida Did Not Meet:





Prenatal and Postpartum Care: Timeliness of
Prenatal Care (PPC)
Frequency of Ongoing Prenatal Care (FPC)
Weight Assessment and Counseling for
Nutrition and Physical Activity for Children and
Adolescents: Body Mass Index for
Children/Adolescents (WCC)
Well-Child Visits in the 3rd, 4th, 5th and 6th
Years of Life (W34)
Adolescent Well-Care Visits (AWC)
WELL-CHILD VISITS IN THE 3RD, 4TH, 5TH AND
6TH YEARS OF LIFE (W34) BY PROGRAM
0.2%
0.3%
1.3%
0.9%
0.3%
100%
80%
Benchmark: 71.8%
Rate
60%
40%
77.0%
75.3%
75.7%
74.4%
62.8%
20%
0%
TXIX CMSN
TXIX PCCM
Title XIX
TXIX HP
TXXI MediKids
TXXI Healthy Kids
Title XXI
ADOLESCENT WELL-CARE VISITS (AWC)
BY PROGRAM
1.8%
1.3%
3.5%
0.7%
100%
80%
Rate
60%
Benchmark: 46.8%
40%
58.7%
20%
49.8%
48.1%
TXIX PCCM
TXIX HP
53.8%
0%
TXIX CMSN
Title XIX
TXXI Healthy Kids
Title XXI
REGISTRY MEASURES 2012
REGISTRY MEASURES

These Measures Include:
Percentage of Live Births Weighing
Less than 2,500 grams
 Cesarean Rate for Nulliparous
Singleton Vertex
 Childhood Immunization Status (CIS)*
 Immunization for Adolescents (IMA)*

*Discussed on slide “What’s New in 2012?”
CONSUMER ASSESSMENT OF
HEALTHCARE PROVIDERS AND
SYSTEMS (CAHPS) 2012
COMPOSITES THAT FLORIDA HAS MET
NATIONAL BENCHMARKS

How Well Child’s Doctor Communicates

Customer Service

Getting Needed Information

Overall Ratings for Child’s Personal Doctor

Overall Ratings for Child’s Specialist

Overall Ratings for Child’s Health Care

Overall Ratings for Child’s Health Plan
COMPOSITES THAT FLORIDA HAS NOT
MET NATIONAL BENCHMARKS

Getting Needed Care

Getting Care Quickly

Shared Decision Making
Getting Specialized Services
Coordination of Care and Services
Personal Doctor Who Knows Child
Getting Prescription Medicine




WHAT WAS NEW IN 2012?

Improvements in the registry measures
 Using FL SHOTS data greatly increased compliance for all three
Immunizations for Adolescents submeasures for FHKC enrollees.
HYBRID MEASURE ANNUAL PEDIATRIC
HEMOGLOBIN (HBA1C) TESTING AND CONTROL

Comparison of results of administrative and hybrid
method
WHAT’S NEW IN 2013?

Three new quality measures
Human Papillomavirus (HPV) Vaccine for Female
Adolescents
 Medication Management for People with Asthma
 Behavioral Health Risk Assessment for Pregnant
Women*


Two retired measures
Otitis Media with Effusion – Avoidance of
Inappropriate Systemic Antimicrobials in Children
 CLASBI


Florida will report 24/25 measures
SUMMARY
Quality measurement is here to stay
 Measurement is not enough, the last 2 years
of the CHIPRA grant will begin to focus on
dissemination of information and ultimately,
improvement.

What you do for Medicaid and CHIP
enrollees matters!
THOSE WHO SAY IT CANNOT BE
DONE SHOULD NOT INTERRUPT THE
PERSON DOING IT.
-Chinese Proverb
CONTACT INFORMATION:
The Institute for Child Health Policy
at the University of Florida
www. ichp.ufl.edu
Caprice Knapp, PhD
[email protected]

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