CHIPRA Quality Demonstration Grant. QTIP - Hobbs
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1 CHIPRA Quality Demonstration Grant Kristine Hobbs, LMSW Lynn Martin, LMSW
2 Let the practices set their own priorities with the goal of moving each practice toward integration ALL kids are their kids Find and use your mental health champions Help connect grant activities to what they are already doing Frame mental health in the context of physical health Pay them for what they do Provide guided outreach to community resources Keep the message front and center in both big and small ways
3 CHIPRA Core Measures: Category A Experiment with, and evaluate the use of, new measures for quality in children s health care EHRs/HIT: Category B Promote the use of Health Information Technology (HIT) for the delivery of care for children Medical Home/Behavioral Health: Category C Evaluate provider-based models which improve the delivery of children s health care services QUALITY through TECHNOLOGY and INNOVATION in PEDIATRICS
4 Demographics Business Models: o FQHCs, RHCs, academic practices, privately owned, or hospital owned Sizes: o From 1 doc to 18 docs; some have NPs EMR systems: o 11 different EMR systems; 2 still using paper charts Medicaid Populations: o Range from 43 to 98% Communities: o Rural, suburban, and urban (for SC) Desire for integration: o Attitudes ranged from I don t do mental health.. I have to do mental health Grant interests o May have been more interested in other parts of grant rather than integration or vice versa
5 Learning Collaborative Semi-annual sessions attended by QI team Quality measures presented, expert speakers, PCMH and behavioral health concepts, information sharing, etc. On-Site Visits QTIP team technical assistance site visits Peer reviewer participation Academic detailing Mental Health education and community resource meetings Quality Improvement coaching Pediatric Practices 18 practices selected Each practice identified a QI team lead: practitioner, nurse and office manager Plan-Do-Study-Act cycles Practices document quality improvement work Maintenance of Certification Physicians can earn Part IV MOC credit on QI work Planning & Steering Committee Active committee; meets quarterly
6
7 From the grant: Behavioral health is fully integrated into our demonstration grant as Category C which specifically focuses on the integration of behavioral health care within the medical home Pediatric Visits Pediatrics, % of pediatric primary care visits involve behavioral, emotional or developmental concerns Suicide 3rd leading cause of death yr olds 4th leading cause of death yr olds
8 Refine Family Involvement Identify current mental health integration w/in QTIP practices Environmental scan of mental health services Assess current utilization of validated mental health screening tools Identify mental health screening tools with quality measures Tasks from the Grant Begin recruitment of MH providers Explore telemedicine options with DMH Integration of MH models w/in practices -Incorporate developmental and mental health screenings into practice models -Provide assistance -Work with community supports, other state agencies Research & Identify a certification program Initiate Training/ Certificate Program in Primary Care behavioral health with MH providers NCQA tasks, additional QI measures Review family involvement -Assess degree of family involvement -Incorporate recs made by P&S and QTIP practices Refine integrated mental health practice model -Incorporation of prevention strategies and screening such as maternal depression, substance abuse, community connectedness to address prevention services. -Incorporation of treatment services with QTIP practices Boots on the Ground -- TA visits with medical director; specific site visits without medical director, community visits with providers, site specific problem solving
9 Start where the practice is Provide consistent contact and messaging Provide tangible and desired resources Visit community providers together
10 5 Categories Framework for Grant Activities Community Resources Health Care Financing Support for Children and Families Clinical Information Systems/Delivery Systems Redesign Decision Support for Clinicians
11 2012, 2013, & 2014 QTIP Averages and Total Possible Points AAP Mental Health Practice Readiness Inventory Support For Children & Clinical Info/Systems Decision Support for Community Resources Health Care Financing Families Redesign Clinicians QTIP Average QTIP Average QTIP Average Total Possible
12 Date Presentation Content Surveys and Resources Jan 2011 July 2011 ADHD Holy Cow! Mental Health: It s not all it s cracked up to be yet! All practices choose top 3 priorities from list of 21 options Jan 2012 MNOPs of Behavioral Health AAP s MHPRI; NAMI resources July 2012 Jan 2013 July 2013 Jan 2014 July 2014 Think, Think, Think. Keeping mental health on the agenda. General mental health focus- Screening, AAP Toolkit, office processes, family involvement Focus on Mental Health Adolescent health focus Toxic stress factors and medical home interventions TBA In Process Jan 2015 Celebration Time! Oh! Yeah! AAP MHPRI AAP s MHPRI; AAP MH Toolkits; Level of Integration Measure; AAP Pamphlets Homegrown questionnaires about screening and resources; AAP Book on Adolescent Health AAP s MHPRI; homegrown survey about grant
13 Time Spring 2011 Fall 2011 Spring 2012 Fall 2012 Spring 2013 Fall 2013 Spring 2014 Fall 2014 Topics Explored; Resources Shared. General Grant Questionnaire; Federation of Family Posters ACE study; school-based resources; authorization cheat sheet; LIPS providers; MH Handouts; Fed of Family Referral Packets AAP s MHPRI AAP suggestions Review original questionnaire; clinical resources; AAP s MHPRI results AAP suggestions Implementation of screening protocols; billing; processes Visits are becoming more site specific Visits continue to be more site specific 9 practices have asked for specific visit outside of TA visit to focus on mental health All practices are visited at least twice yearly. Some request additional visits.
14 Just to name a few: CHADIS Pilot UMASS Certificate Programs in Primary Care Behavioral Health & Integrated Care Management Academic Detailing ADHD, Anti-psychotics Community Visits with recommendations for feedback loops Mental Health Specific Site Visits Liaison with community serving providers Liaison with Family Advocacy Groups AAP Mental Health Toolkits s to specific providers about training/grant opportunities Training to office staff on MH Psychiatric Consultant (new) Training opportunities for providers and staff
15 Just to name a few: Jan 2011 physician rate reduction due to SCDHHS budget deficit Summer 2010 Licensed Independent Practitioners enrolled April 2012 BH carved into MCOs SC DMH - funding and criteria for services moving target PCMH NCQA 2013 statewide incentives Statewide initiatives - obesity; SBIRT; System of Care
16 Top 6 of 21 Options Practices Chose in July 2011 Finding ways to access child psychiatry Work with community providers to facilitate accessing local resources Identify a list of resources for specific needs in your community Learn more about billing and coding for mental health services Identify appropriate and time effective assessment and screening tools Information about funding/billing options for co-located staff Most Useful/important/helpful thing we have done to facilitate integration: Tangible resources Screening protocol Reimbursement mechanisms in place for screenings Constant discussion and reinforcement
17 Top 6 of 21 Options Practices Chose in July 2011 Finding ways to access child psychiatry Work with community providers to facilitate accessing local resources Identify a list of resources for specific needs in your community Learn more about billing and coding for mental health services Identify appropriate and time effective assessment and screening tools Information about funding/billing options for co-located staff Most Useful/important/helpful thing we have done to facilitate integration: Tangible resources Screening protocol Reimbursement mechanisms in place for screenings Constant discussion and reinforcement
18 Year Community Visit w/ Practice On-Site Visits Totals
19 Resulted in 2 Medicaid Bulletins: EPSDT screening Behavioral Health Screening Clarification SC QTIP Recommended Routine Screening Protocol Babies and Preschoolers Elementary School Adolescents Developmental Screening ALL: ASQ-3 or PEDS MCHAT Psychosocial/Environmental Risk Factors - ALL Edinburgh Post-Partum depression screen for moms SEEK-PSQ All: PSC parent report If indicated: SCARED 8+ Vanderbilt All: PSC-Y 11+ If indicated or desired: Modified PHQ-9 CRAFFT SCARED Vanderbilt
20 94% using 1 or more screens 89% using ASQ, PEDS, or MCHAT 72% - using PEDS or ASQ 72% - using MCHAT Self-Report - QTIP Practices Routine Screening (n = 18) Peds or ASQ MCHAT Edinburgh PSC PSC-Y CRAFFT routine use prior to QTIP routine use now
21 Practices say they will: Monitor screening Continue screening Resource linkages for needs identified on screens Practices Want MH Coordinator to Work: More billing and funding More specialists Better access Continued Liaison and advocacy between practices and others
22 Continued systems changes Limited resources Multi-layered authorization processes Payment mechanisms to support the work being done Buy-in Many models needed to meet skills, business structure, local resource base Payment for integration is not in place Differing levels of comfort and skill of practitioners
23 More of the Same Training Opportunities for Providers Access to Specialists and Crisis Response Reimbursement Strategies for Integration Continued advocacy and liaison work
24 Let the practices set their own priorities with the goal of moving each practice toward integration ALL kids are their kids Find and use your mental health champions Help connect grant activities to what they are already doing Frame mental health in the context of physical health Pay them for what they do Provide guided outreach to community resources Keep the message front and center in both big and small ways
25 We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty. Maya Angelou caterpillar-to-butterfly1.jpgramkiboli.blogspot.com
26 Lynn Martin Kristine Hobbs
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