CHIPRA Quality Demonstration Grant:

1. CHIPRA Quality Demonstration Grant:

2. Two Year Review of “Going Where No Man Has Gone Before…” What we accomplished What we still need to do

3. South Carolina chose categories: • CHIPRA Measures: • Category A – Experiment with, and evaluate the use of, new measures for quality of Medicaid/ CHIP children’s health care • EHRs: • Category B – Promote the use of Health Information Technology (HIT) for the delivery of care for children covered by Medicaid/CHIP • Medical Home/Behavioral Health: • Category C – Evaluate provider-based models which improve the delivery of Medicaid/CHIP children’s health care services

4. The South Carolina grant has four key goals: • Quality: demonstrate that newly developed quality measures can be successfully utilized in pediatric practices; • Technology:share key clinical data through a statewide electronic quality improvement network; • Innovation:develop a physician-led, peer-to-peer quality improvement network; and • Pediatrics:expand the use of pediatric medical homes to address mental health challenges of children in our state.

5. Year One = Planning YearFebruary 2010 – January 2011 • Staff and Contractors Selected • 18 Practices Selected • HIT and reporting development • Evaluation planning • Baseline data gathering • Implementation of blog and tracking mechanisms

6. Year One = Planning YearFebruary 2010 – January 2011 • First Learning Collaborative held • January 23-24, 2011; attended by 66 QTIP pediatric office staff • 4 quality indicators introduced ADHD, Emergency Department Visits, 15 Month Well Child Visits and Developmental Screenings • Overview of Patient Centered Medical Homes presented • Participation payments made

7. Year 2 February 2011 – January 2012 2nd Learning Collaborative: • July 23-24, 2011 and attended by63 staff from 18 pediatric practices • 3 quality measures introduced; 2 NCQA – PCMH standards; and Mental Health CAHPS, Access, Preventative Dental; PCMH standards (1 and 6): Access and Continuity: Measure and Improve Performance

8. Year 2 February 2011 – January 2012 HIT assistance/development • Behind the scenes work with each practice to capture data for the reports • Historical data has been down loaded from 2 practices • Adapter and Driver development • VPN (site to site) • CHIPRA data registry is available for practices without an EMR Quality reporting • Work is being performed to review and incorporate data download from CareEvolution • Anticipate reports to practices (submitting data) Spring 2012

9. Year 2 February 2011 – January 2012 • Evaluation • CAHPS survey completed and results provided to the 15 non-academic practices • Baseline data gathered on the CHIPRA quality HEDIS and HEDIS-like measures • Analysis on practice’s stated successes/challenges and reporting via PDSA and QI meeting is occurring • Development of evaluation tools • Coordination of evaluation activities with the National Evaluation Team

10. Year 2 February 2011 – January 2012 • Mental Health: • Data gathering and resource sharing • 9 practices currently have a Mental Health provider of some capacity within their practice • 4meetings facilitated by QTIP staff in communities increase awareness and coordinate services • One meeting resulted in plans for co-location of a DMH staff 1 afternoon/week in a QTIP practice • CHADIS screening tool is being piloted by 3 practices

11. Year 2 February 2011 – January 2012 • 37 Technical Assistancevisits by Dr. Rushton • 228 pediatric staff participated in the Spring visits • 180 pediatric staff participated in the Fall visits • 13 peers participated in the on-site visits

12. QTIP AWARDMost Peer Site Visits Katie Stephenson

13. QTIP Award Most Interesting Staff Bathroom Art February 2012 Carolina Pediatrics in Cheraw

14. Year 2 February 2011 – January 2012 • Academic Detailing: • ADHD informational on-site visits conducted • 129 practitioners participated in the initial ADHD visit • 82 practitioners participated in the follow-up ADHD visit • 28 practitioners have submitted requests for CEU certificates • Work started on Asthma

15. Quality - To Date: “To demonstrate that newly developed quality indicators can be successfully utilized in pediatric practices” Collection of CHIPRA Quality Measures • Part IV MOC Credits were earned by 9 doctors in 4 QTIP practices for their work on ADHD • 7 measures introduced at January and July 2011 Learning Collaboratives • As of January 31, 2012, 298 PDSA cycles have been documented.

16. Quality - To Date: WHAT DID YOU DO? Collection of CHIPRA Quality Measures • 207 PDSA cycles have been documented reflecting work done between July to January 2012. Top 4 Categories/Frequencies • 90 Developmental Screening • 60Preventative Dental • 39 ED • 38 ADHD

17. QTIP AWARDMost DocumentedPDSA Cycles (July 2011 – January 2012) Beaufort Pediatrics

18. WHAT DID YOU DO? Quality improvement team within the pediatric setting • Over 217quality meetings documented from January 2011 to January 2012. • 138meetings were documented between July 2011 and January 31, 2012.

19. QTIP AWARDMost DocumentedQI Meetings (July 2011 – January 2012) Children’s HospitalOutpatient Clinic

20. Years 1 and 2Let’s Not Forget…. • All MOAs have been signed! • $tipend payments made for 5 quarters • QTIP trained and certified 126 practice staff to administer fluoride varnish • There have been 136 Postings and 66 comments on the blog between July and January 2012.

21. QTIP AWARDMost Staff Trained in Fluoride Varnish Center for Pediatric Medicine

22. QTIP AWARDMost Blog Entries (July 2011 – January 2012) Debbie Greenhouse

23. Now… Where are we going? • Where We Are • Where We Want to Go

24. Year 3 TasksFebruary 2012 – January 2013 • Learning Collaboratives • Introducing additional quality measures • NCQA – PCMH standards • Expansion of MOC Part IV credits • Technical assistancesite visits will be conducted between March – June 2012 • Dr. Rushton (and QTIP team): to discuss QTIP and work on quality measures • SCORxE: to present information on Asthma

25. Year 3 TasksFebruary 2012 – January 2013 • Review of family involvement and family-centered care • Behavioral Health • Training/certification program available • Incorporation of prevention strategies and treatment strategies • Assessment tools • Brokering with community resources • Evaluation Activities • In-State and National • CAHPS • Feedback

26. Year 3 HIT assistance • Continue to work on SCHIEx connection • Connectivity and data gathering from EMR • Installing CHIPRA Data Registry in practices without and EMR Quality Reports available Spring 2012 • Report Data Sources: • EHR (or QTIP Data Registry) • Claims • Reports By: • Practice and Month • Report Design • Metrics: Supportive of HEDIS • Display: Graphical

27. Report Template

28. Now For Today… TODAY • Introducing 4 additional quality measures • Asthma • Low Birth Weight • C-Section rates • Prenatal Care • Presenting 2 additional NCQA – PCMH elements • Identify and Manage Patient Population • Track and Coordinate Care

29. And Within the Next 6 Months… • Work on the 4 new quality measures, NCQA- PCMH and Behavioral Health • Actively take part in evaluation efforts (State, National) • Send and receive data through your EMR or CHIPRA Data Registry • Connect to SCHIEx • Participate in on-site visits (peer, Dr. Rushton, QTIP staff and SCORxE)

30. TO DOCUMENT!

31. If it’s not documented…it’s not done… • DOCUMENT

32. Help us show what you are doing is working………. • DOCUMENT

33. Thank you for your continued work and devotion to this project.Focus of SC Grant South Carolina believes that children will achieve the best health outcomeswhen they receive care through an integrated medical home that addresses all their health needs—both physical and mental—and participates in continuous quality improvement efforts.