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Performance Improvement Projects (PIPs): Agency Findings

Explore successful Performance Improvement Projects (PIPs) to boost prenatal and well-child visit rates, analyze barriers, implement interventions, and collaborate for better outcomes. Strategies, data, and innovative interventions are highlighted for enhanced care services.

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Performance Improvement Projects (PIPs): Agency Findings

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  1. Timeliness of Prenatal Care Well-Child Visits in First 15 mos. Performance Improvement Projects (PIPs):Agency Findings - Successes, Opportunities, and Sharing Best Practices - Janicka D. Harris, MPH Bureau of Medicaid Quality Agency for Health Care Administration External Quality Review Meeting Wednesday, November 2, 2016

  2. Timeliness of Prenatal Care (PPC-Pre) National Medicaid Rate FFY 2012 83% National Medicaid Rate FFY 2013 82% National Medicaid Rate FFY 2014 82% FL MMA Statewide Average CY 2015 83% Increase the percentage of women who had a live birth baby that received a prenatal care visit as an enrollee of the managed care plan in the first trimester OR within 42 days of enrollment to achieve NCQA Quality Compass 75th percentile.

  3. Well-Child Visits in First 15 mos. (W15) National Medicaid Average 2012 64% FL MMA Statewide Average CY 2015 58% National Medicaid Average 2013 62% National Medicaid Average 2014 59% Increase the percentage of children who are 15 months of age during the measurement year and have 6 or more Well-Child visits to achieve the Quality Compass 75th percentile.

  4. PPC-Pre and W15 PIP Analysis 11 plans submitted a Prenatal Care and Well Child Care PIP for evaluation. 1 plan submitted a W15 PIP only ALL plans listed barriers and interventions!!

  5. PPC-Pre / W15 PIP Barrier Analysis

  6. PPC-Pre and W15 Intervention Analysis

  7. PPC-Pre and W15 Interventions ACTIVE PASSIVE Provider/ Member Newsletters Brochures Postcards Print Materials Member Invitations/ Announcements Reminder Letters • Member Rewards Programs • Provider Quality Incentive Programs • Provider Performance Report Cards • Routine Live Outbound Appointment Calls • Utilization of Florida SHOTS Registry

  8. Opportunities for Improvement • Plans may include interventions focused on addressing health disparities. • Encourage consistent communications between behavioral health and primary care providers, and obstetricians. • Plans may list 3 or 4 “high” priority barriers and link them to corresponding interventions. • Plan may incorporate interventions focused on members who are high-risk for pregnancy complications and who have a mental health condition.

  9. Need Help? Just Ask  Research. Data Collection. Tools. Strategy. • HSAG will provide Technical Assistance. • The Agency, Bureau of Medicaid Quality serves as a resource to assist the plans with their innovative strategies related to your PIP study topics. • Research resources and helpful tools.

  10. Unique Interventions: PPC-Pre & W15 Member-level Timeliness of Prenatal Care & W15 Healthy Behaviors Perinatal Care Programs In-Home Visiting/ Outbound Services • Third Party Vendors Maternal Case Management Programs (e.g., high-risk pregnancies) Use of Social Media (e.g., campaigns, Text4Baby)

  11. Unique Interventions: PPC-Pre & W15 Provider-level Timeliness of Prenatal Care & W15 Provider Engagement/ Advisory Group Provider Quality Incentive Programs Pediatric/ Primary Care Provider Performance Report Card W15 Compliance Audits of Medical Records

  12. Unique Interventions: PPC-Pre & W15 Systems-level Timeliness of Prenatal Care & W15 Community Clinic Days/Baby Showers On-Site Provider Coding/ Billing Training Community & Team-Based Partnerships • Department of Children & Families • Healthy Start Coalition • WIC Program • Third Party Vendors • Large Pediatric Practices

  13. Brainstorm New / Modify Interventions Timeliness of Prenatal Care Address health disparities/Health literacy Utilize Text Messaging Applications Engage fathers or partners Require providers to screen for smoking, domestic violence, & drug/ substance use Promote/Improve postpartum & inter-conception care (e.g., Family Planning Waiver)

  14. Brainstorm New / Modify Interventions Well-Child Visits – 15 mos. Address health disparities/ Health Literacy Provider Performance Awards Program Incentives to parents for scheduling and attending W15 appointment Collaborate or Partner with Early Steps/Head Start

  15. State Interventions: Nevada Cribs for Kids Initiative • Implemented to deploy cribs, or other equipment needed by new moms • Moms that completed the required number of prenatal and postpartum care visits within the required time frames • Distribute safe sleep educational survival kits. • http://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Members/BLU/FY2015_EQR_Technical_Report.pdf https://www.hpnmedicaidnvcheckup.com/Member/Incentives

  16. State Interventions: California Baby Blocks Program Online and mobile engagement tool aligns with the demographic and ethnographic profiles of California’s Medicaid members (e.g., pregnant) enrolled through direct mail, outreach calls, and provider marketing; e-mail or text reminders about appointments and tips for healthy living. http://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/Studies_Quality_Strategy/MgdCareQualityStrategy2016.pdf

  17. State Interventions: Washington State Children’s Preventive Healthcare Initiative Aim: Increase well child care (WCC) visits and immunization rates for children enrolled in Washington Medicaid’s Healthy Options by 10 percentage points. • Proven Institute for Health Improvement initiative. • Cooperative effort between state policymakers, health plan representatives, and frontline clinic staff. • Develop postcard and telephone outreach to parents of infants and children overdue for a well-child visit. • Develop bilingual reminder postcards. • Develop a system to identify the children overdue for a well-child visit using clinic billing data or managed care health plan data. http://www.ihi.org/resources/Pages/ImprovementStories/ChildrensPreventiveHealthcareInitiative.aspx

  18. Resources/References • American Academy of Pediatrics (Health Literacy) • CDC Contraceptive Guidelines for Health Care Providers http://www.cdc.gov/reproductivehealth/contraception/usmec.htm • Early Childhood Health and Wellness: Health Literacy & Family Engagement: https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/health/health-literacy-family-engagement • Medicaid Quality Innovation Center https://ahca.myflorida.com/Medicaid/Policy_and_Quality/Quality/clinical_quality_initiatives/index.shtml • Mobile Apps • Sense Health: https://www.sensehealth.com/ • Text4Baby: https://www.text4baby.org/ • iBirth: http://www.ibirthapp.com/ • News Article (e.g., connecting hard to reach via technology) http://www.modernhealthcare.cm/article/20150805/NEWS/150809942 • Reproductive Training for Health Centers http://www.upstream.org/

  19. Questions/Comments?

  20. Thank You!! Janicka D. Harris, MPH Bureau of Medicaid Quality Agency for Health Care Administration janicka.harris@ahca.myflorida.com (850) 412-4686

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