Care Coordination under the Medicaid Benefit for Children and Adolescents

Transcription

1 Care Coordination under the Medicaid Benefit for Children and Adolescents Tuesday, September 9, :00 4:00 pm ET For audio, please listen through your speakers or call: Follow NASHP on Supported by the Centers for Medicare & Medicaid Services under a contract to NORC at the University of Chicago Agenda 3:00 3:05 pm Welcome and Introductions Neva Kaye, Interim Executive Director, NASHP 3:05 3:15 pm Federal Perspective on Care Coordination under the Medicaid Benefit for Children and Adolescents Rosemary Feild, Insurance Specialist, CMS 3:15 3:40 pm Insights from States Dana Hargunani, Child Health Director, Oregon Health Authority Chris Collins, Director, Office of Rural Health and Community Care, North Carolina Department of Health and Human Services 3:40 3:55 pm Question and Answer Facilitator: Neva Kaye 3:55 4:00 pm 1 Wrap-up 1 1

2 Resources for States NASHP has launched a Resources to Improve Medicaid for Children and Adolescents map: The map offers: State-specific resources on several topics, including data collection, care coordination, and behavioral health Strategies that state policymakers and Medicaid officials are using to deliver the Medicaid benefit for children and adolescents Additional national resources 2 A Federal Perspective on Care Coordination under the Medicaid Benefit for Children and Adolescents Rosemary Field Health Insurance Specialist Division of Quality, Evaluation & Health Outcomes, Center for Medicaid and CHIP Services Centers for Medicare & Medicaid Services 3 2

3 Making Connections: Strategies for Strengthening Care Coordination in the Medicaid Benefit for Children &Adolescents One of a series of strategy guides to help states improve child health services delivered through Medicaid and CHIP. Intent of this strategy guide: Support states to effectively deliver services to enrolled children by sharing state strategies on care coordination, in order to improve the care experience and improve health outcomes. Inform states of federal authorities and CMS resources that support care coordination in current and emerging delivery system models. Available at: Information/By-Topics/Benefits/Early-and-Periodic- Screening-Diagnostic-and-Treatment.html 4 What is Care Coordination? Care coordination involves a range of activities to help connect a child to services while assisting the family in providing for the child s care. Care Coordination is: Comprehensive: All services a child receives, including services delivered by systems other than the health system, are coordinated. Patient-centered: Care coordination is intended to meet the needs of the child and the family, both developmentally and in addressing chronic conditions. Access and Follow-up: Care coordination is intended not only to connect children and their families to services, but also to ensure that services are delivered appropriately and that information flows among care providers and back to the primary care provider. 5 3

4 Why Care Coordination is Important Care coordination helps to ensure that individual children get the health care they need when they need it the right care to the right child at the right time in the right setting. Care coordination is particularly important for children with special health care needs. 6 Strategies to Strengthen Care Coordination Strategy 1: Build Care Coordination into Provider Standards for Medical Homes Strategy 2: Support Primary Care Providers through Separate Care Coordination Entities Strategy 3: Build Care Coordination Requirements into Contracts with Managed Care Strategy 4: Implement a Multi-faceted Intervention to Improve Coordination Across Systems 7 4

5 Federal Authorities for Care Coordination State Plan Amendments Targeted Case Management State Plan Amendment ACA Section 2703 Health Home State Plan Amendment 1932(a) State Plan Amendment (voluntary/mandatory PCCM/MCO) Primary Care Case Management Contract Integrated Care Model State Plan Amendment State Contracting Authority (1915(a) voluntary managed care) Waivers 1915(b) Freedom of Choice Waiver 1915(c) Home and Community-Based Waiver Section 1115(a) Demonstration Waiver 8 Federal Support for Care Coordination Policy Guidance: Medication Assisted Treatment for Substance Use Disorders Policy Considerations for Integrated Care Models Coverage of Behavioral Health Services for Children, Youth, and Young Adults with Significant Mental Health Conditions CMS Funding: State Innovation Models Initiative CHIPRA Quality Demonstration Grants Health Care Innovations Awards. Accountable Care Organizations Comprehensive Primary Care Initiative Other HHS Initiatives: Early Childhood Comprehensive Systems (HRSA grants) Project LAUNCH (SAMHSA grants) 9 5

6 The Future of Care Coordination Building ACA section 2703 Health Homes for Chronic Conditions to coordinate care for Medicaid beneficiaries with chronic conditions. Paying for care coordination using procedure codes that were created in 2008 in order to reimburse for medical team conferences; and 2013 to reimburse for services including complex chronic care coordination services and transitional care management services. Testing new integrated care delivery systems designed to improve care coordination such as Accountable Care Organizations, Coordinated Care Organizations, and Coordinated Care Entities. Adopting quality measures for care coordination as developed through the Centers for Excellence, and CHIPRA quality grants. 10 Washington Oregon North Colorado Carolina Dana Hargunani, Child Health Director, Oregon Health Authority Chris Collins, Director, Office of Rural Health and Community Care, North Carolina Department of Health and Human Services Insights from States 11 6

7 We understand that both Oregon and North Carolina are building on patient-centered medical home infrastructure to coordinate care for children in Medicaid. Tell us about your states models and how they apply to children. 12 Oregon s Patient-Centered Primary Care Home (PCPCH) Program Oregon s PCPCH Model is defined by six core attributes, each with specific standards and measures set through a public process: Access to Care Be there when we need you Accountability Take responsibility for us to receive the best possible health care Comprehensive Whole Person Care provide/help us get the health care and information we need Continuity Be our partner over time in caring for us Coordination and Integration Help us navigate the system to get the care we need safely and timely Person and Family Centered Care recognize we are the most important part of the care team, and we our responsible for our overall health and wellness 13 7

8 Tiered Levels of Primary Care Home-ness Advanced Primary Care Home Proactive patient and population management Accountable for quality, utilization and cost of care outcomes Intermediate Primary Care Home Demonstrates performance improvement Additional structure and process improvements Basic Primary Care Home Foundational structures and processes 14 Success in PCPCH Enrollment Spending for primary care and preventive services are up 20% Enrollment in PCPCH has increased by 52% since baseline 15 8

9 Patient-Centered Medical Home (PCMH) Role in Coordinating Care for Children Primary care case management (PCCM) infrastructure in place since 1991 Linked Medicaid recipients to a primary care provider Developed Community Care of North Carolina (CCNC) Networks in 1998 Care management services Community health teams Funding with a Medicaid pm/pm payment State Plan Amendment Enhanced over time: Assuring Better Child Development (ABCD) Funded with smart start resources and CCNC network pm/pm Health check coordinator Funded through per member per month (pm/pm) Medicaid Public health care managers Medicaid converted targeted case management to PM/PM CHIPRA Funded by CMS Quality Measures Medical homes for children with special needs Pediatric electronic health record (EHR) 16 Additional Resources For Practice Transformation Opportunities that financially support PCMH Medicare Advanced Primary Care Practice (MAPCP) Demonstration (CMS) Meaningful use (CMS) Blue Quality Physician Program (BlueCross BlueShield of NC) Technical assistance that supports PCMH CCNC web based modules on PCMH CHIPRA Maintenance of Certification IV training / Quality Improvement Specialist Regional Extension Centers NC Medical Society Foundation 17 9

10 Quality Improvement Activities That Support PCMH Well-Care General Bright Futures 2014 Periodicity Schedule Health Check Billing Guide (Visits and coding grid) Medicaid Billing and Coding Myths one pager BMI %ile V codes one pager (2-20 yr olds) Surveillance and Screening one pager (0-20 yr olds) Getting Started Worksheet for office workflow implementation of screening Developmental & Social-emotional screens chart (0-20 yr olds) Common Factors one pager MOC 4 (links) 0-3 yrs ABCD Well-visit rainbow handouts: 0-30 months and behavioral handouts First 1000 days Promotion of EBCD grid by well-visit schedule (link to Newborn Hearing Screening and follow-up materials Dental Varnishing one pager PORRT Lead Screening materials Edinburgh Postpartum Depression screen Maternal Depression one pager ASQ-3 and PEDS (links to publishers for ordering) MCHAT - R/F CDSA Referral Form ABCD how to refer one pager Asthma Visit materials utilizing Shared Decision Making (low literacy) Population management, pre-visit and visit workflow algorithms Steps for completing an asthma action plan ADHD PowerPoint on the 2011 AAP guidelines Vanderbilt Screening Sample communication forms between PCC and school Adolescent Depression Co-management guidelines (pending) Foster Care Initial visit components Comprehensive visit components AAP Visit frequency guidelines Obesity NICHQ/Eat Smart Move More protocol Visits based on risks, frequency; CPT and Dx coding Parent/family materials for use with motivational interviewing in visit (low literacy) Sickle Cell Co management guidelines (in process)

11 How are you using data to support care coordination and measure outcomes? What have you found so far? 20 Role of Data in Care Coordination & Measuring Outcomes Data available Claims data Practice chart review Health Information Exchange clinical data sets Supplemental data Sure scripts / Risk adjustments Tools for data exchange Web based Case Management Information System (CMIS) Pharmacy Home Population health reports preventative, disease specific, high risk, quality, care alerts, etc. Provider Portal 21 11

12 Robust Array Of Reports That Are Claims And Clinically Derived And Are Actionable 22 Available to State, Networks, Medical Homes, Public Health, Mental Health, Social Services Pediatrics Early, Periodic, Screening, Diagnosis & Treatment (EPSDT) Pediatric Pillars Data Practice Support Risk Strati1ication Quality Improvement (PCC training & MOC- IV) Population Management Network Pediatric Teams Pediatric EHR Format Medical Homes Prevention Well Visits Vision & Hearing BMI Percentile Coding Lead Screening Immunization Oral Health Routine Screening (all ages) ADHD Mental Health Integration Maternal Depression Screening Adolescent Depression Screening Social/Emotional/Developmental Asthma Foster Care Obesity Sickle Cell Language & Communication Delays management/pediatrics/ Children and Youth with Special Health Care Needs 23 12

13 Oregon CHIPRA Quality Demonstration Grant One of 10 CHIPRA grantees, Oregon is working with Alaska & West Virginia to: Assess how a core set of children's quality measures can be used to improve quality of care for children Understand the use of health information technology (IT) to enhance service quality and care coordination Implement a comprehensive provider-based model of service delivery In Oregon, the Oregon Pediatric Improvement Partnership and the Oregon Rural Practice-Based Research Network developed a multi-year learning collaborative: Enhancing Child Health in Oregon (ECHO) ( ) ECHO consisted of 8 primary care practices (5 Pediatric, 3 Family Medicine), mixture of urban and rural, focused on implementing medical home concepts in pediatric primary care settings 24 Oregon Health Authority: Quality and Accountability State Performance Measures Annual assessment of statewide performance on 33 measures Financial penalties to the state if quality goals are not achieved Coordinated Care Organization (CCO) Incentive Measures Annual assessment of CCO performance on 17 measures Compare performance to 2011 baseline Monthly data shared with CCOs so data can be validated and progress can be monitored throughout the year 2013 quality pool funds allocated to CCOs annually 25 13

14 Developmental Screening by Race/Ethnicity 26 Visit Oregon s page on NASHP s new resource compendium to learn more: You will find materials including links to: Information on the data collection and measurement strategy for Oregon Coordinated Care Organizations Resources on behavioral health services available to children in Oregon Information on the coordinated care model associated with the Coordinated Care Organizations and much more! 27 14

15 What do you each see as the emerging issues in your states or nationally that will impact care coordination for children going forward? 28 Health System Transformation: Coordinated Care Organizations Better health, better care, lower costs through fundamental changes that will: o Better coordinate care at patient and financing level o Integrate public, physical, mental and dental health o Leverage public health strategies - recognizes that 10% of health happens in medical system o Measure performance o Engage people in their own health o Pay for outcomes, not activities o Provide clear and transparent information 29 15

16 Early Learning Hubs A self- organized, community- based coordinating body created to provide a system approach to early childhood education that works to improve efficiency and outcomes for our youngest children. Up to 16 regional Hubs serving the state Required to build cross-system partners: health, social services, K12 education, business, and families Three goals: Stable and attached families Kindergarten readiness A more coordinated and effective system 30 Coordination of Care: Bridging Health and Early Learning Systems CCOs required to complete a community needs assessment and a Community Health Improvement Plan (CHIP) to drive CCO work Example: Eastern Oregon Coordinated Care Organization Largest service area including 12 counties (10 are considered frontier ) Needs assessment: quantitative/qualitative data Local CHIPS developed for each county Regional prioritization informed final CCO CHIP Ranking of priorities: Early Childhood #1 Goal: improve health outcomes for children ages 0-5 through integrated services Strategy: establish regular communication and strategic planning with each Hub in region; increase developmental screening & prenatal care Evidence: Collective impact 31 16

17 Emerging Issues That May Impact Care Coordination For Children Transparency of data All Payer claims data base Health Information Exchange State funds assisting safety net providers to connect Legislation with regards to Medicaid clinical data CMS CHIPRA Part D demonstration will define electronic health records and key pediatric clinical records. Passports and shared care plans for high risk populations. 32 Continued Emerging Issues Integrated team based systems of care Movement toward accountable care organizations (ACOs) - (Medicare, Medicaid and BCBS) Medicare ACOs Impact of Medicare care management codes 33 17

18 Visit North Carolina s page on NASHP s new resource compendium to learn more: You will find materials including links to: Information on Community Care of North Carolina s medical home model Provider toolkits with pediatric tools for Medicaid primary care providers Information on North Carolina s CHIPRA Quality Demonstration Grant. and much more! 34 Chris Collins Director, Office of Rural Health and Community Care North Carolina Department of Health and Human Services Dana Hargunani Child Health Director Oregon Health Authority dana.hargunani@state.or.us chris.collins@dhhs.nc.gov Rosemary Feild Insurance Specialist Centers for Medicare & Medicaid Services Rosemary.Feild@cms.hhs.gov Neva Kaye Interim Executive Director and Managing Director for Health System Performance National Academy for State Health Policy nkaye@nashp.org 35 18

19 Questions and Answers Questions for the presenters? Please type them into the chat box now! 36 Thank You! Please fill out your evaluations! For additional resources, Visit epsdt/resourcesimprove-medicaidchildren-andadolescents 37 19