Quality in Medicaid and CHIP: From Vision to Reality Facilitated by Marsha Lillie-Blanton Director, Division of Quality, Evaluation & Health Outcomes Chief Quality Officer, Center for Medicaid and CHIP Services The CMS Healthcare Quality Conference Baltimore, MD December 2 4, 2014 Follow us on Twitter: @QIOProgram Tweet with our conference hashtag: #QualityNet14
CMS QualityNet Conference Kickoff and Technical Assistance Team Introductions Marsha Lillie-Blanton Director, Division of Quality, Evaluation & Health Outcomes Chief Quality Officer, Center for Medicaid and CHIP Services
Agenda Grantee Welcome Eliot Fishman The CMCS Maternal and Infant Health Initiative JudyAnn Bigby The CMS Oral Health Initiative Patrick Finnerty 3
Center for Medicaid and CHIP Services (CMCS) Grantee Welcome Eliot Fishman Director, Children & Adults Health Programs Group Center for Medicaid and CHIP Services
The CMCS Maternal and Infant Health Initiative JudyAnn Bigby Clinical Advisor, Center for Medicaid and CHIP Services QI 301 Series Senior Fellow, Mathematica Policy Research
Agenda Overview of the Maternal and Infant Health Initiative Importance of this initiative to improve women s health What are some of the opportunities? What are some of the challenges and how can we overcome them? 6
Improving the Health of Mothers and Infants in Medicaid and CHIP: Initiative Goals Building on the 2012 Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and CHIP, in July 2014 CMCS launched a multi-pronged strategy to achieve two goals over a 3-year period in 20 states: 1. Increase by 10 percentage points the rate of postpartum visits among women in Medicaid and CHIP 2. Increase by 15 percentage points the use of effective contraception among women enrolled in Medicaid and CHIP 7
Initiative Strategies and Activities Strategies Engage states, providers, and beneficiaries Leverage federal partnerships Strengthen technical assistance Measure quality and improve performance Activities Improving Postpartum Care Action Learning Series Development of quality measure for contraceptive utilization Funding opportunity Quarterly webinars 8
Opportunity to Improve the Postpartum Care Visit Rate Medicaid and Commercial Health Plan Postpartum Care Visit Rates HEDIS 2013 Source: NCQA HEDIS Database 9
Improving Postpartum Care Action Learning Series Eleven states are engaged in quality improvement projects States are exploring a range of strategies Adapting Medicaid payment policies Leveraging contractual agreements with managed care organizations Building supports to engage women in their own care Partnering with community social service agencies Partnering with health homes States also want to address disparities, improve access to contraception, and link their efforts to other initiatives, such astext4baby and the Collaborative Improvement & Innovation Network (CoIIN) 10
Closing Comments Opportunities to build on state experiences Overcoming challenges 11
Contact JudyAnn Bigby Clinical Advisor, CMCS QI 301 Series Senior Policy Fellow, Mathematica Policy Research jbigby@mathematica-mpr.com 12
The CMS Oral Health Initiative Patrick W. Finnerty President, Board of Directors, Virginia Dental Association Foundation Former Virginia Medicaid Director
Medicaid and Children s Oral Health Any Dental Service ages 1-20 2001 28.8% 2007 37.1% 2008 39.0% 2010 46.4% 2011 47.3% 2012 48.0% Events 2001 CMS announces reviews of states with dental utilization < 30% 2007 Congressional hearings 2008 CMS announces reviews of states with dental utilization < 30% 2010 CMS announces oral health initiative 2011 CMS reviews 8 innovative states 2013 CMS sets oral health initiative baselines and goals 14 14
CMS Oral Health Initiative Goals Goal #1 Increase by 10 percentage points the proportion of Medicaid and CHIP-enrolled children ages 1 to 20 (enrolled for at least 90 days) who receive a preventive dental service Baseline year is FFY 2011 National baseline is 42% National progress by FFY 2013 is 44% Goal year is FFY 2015. National goal is 52% Every state has its own baseline and goal Goal #2 Increase by 10 percentage points the proportion of Medicaid and CHIP-enrolled children ages 6 to 9 (enrolled for at least 90 days) who receive a sealant on a permanent molar tooth CMS is working on operationalizing this goal 15
Top 10 States with a 10 Percentage Point or Greater Increase in Preventive Dental Services Percentage of Medicaid-enrolled children, ages 1-20, who received a preventive dental service, FFY 2007 FFY 2011 16 Source: FY 2000-2011 CMS-416 reports, Line 1, Line 1b, 12b Note: FY 2011 data for Idaho, Kentucky and Ohio are not yet available. Estimates for these states are included in the National figure for FY 2011, but they are excluded from consideration as "Top 10" states for this analysis ** In 2010, CMS changed the population measure d from all enrolled children to children enrolled for at least 90 continuous days.
Steady Progress in Access to Dental Care 60.0% FFY 2000 FFY 2012 50.0% 40.0% 30.0% Any Dental Preventive Treatment 20.0% 10.0% 0.0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012* Source: FFY 2000-2012 CMS-416 reports, Lines 1, 1b, 12a, 12b, and 12c. Note: *FFY 2012 data for Connecticut is not yet available and was substituted with FFY 2011 data. Data reflects updates as of 4/03/14. 17
FFY 2011 FFY 2013: Two-Year Progress on Preventive Services Goal 12% Percentage point difference in use of preventive dental services by children, ages 1-20, enrolled in Medicaid for at least 90 days who received a preventive dental service (12b) 10% Five-year Goal 8% 6% 4% Two-year Goal 2% 0% -2% -4% Montana Indiana Iowa Maine Idaho Florida* Nevada Nebraska Kansas New Mexico West Virginia Pennsylvania Utah Michigan New Jersey North Carolina Illinois Maryland Mississippi Missouri Massachusetts Hawaii Connecticut Oklahoma Arkansas Delaware Tennessee Washington New York Georgia National* Louisiana Alabama Wyoming Virginia Vermont Oregon Wisconsin North Dakota New Hampshire District of Columbia Minnesota California Colorad oarizona Alaska Kentucky Rhode Island South Carolina South Dakota Texas 18 Source: FFY 2011-2013 CMS-416 reports, Line 1b, 12b Note: *FFY 2011 data for Ohio and Florida are not available. Data for Florida has been substituted with FFY 2012 data. Data for Ohio has been excluded. Estimates for Florida are included in the National figure. Data has been rounded.
FFY 2013: Percentage of Children in Medicaid Who Received Dental Sealant Percentage of Children, Ages 6-9, Enrolled in Medicaid for at Least 90 Days Who Received a Sealant on a Permanent Molar, FFY 2013 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Massachusetts Illinois Nebraska Connecticut New Hampshire Maine Washington Alaska Kansas Indiana North Carolina Texas Delaware Maryland Colorado Idaho Montana Nevada Tennessee New Mexico Utah District of Columbia Iowa California Vermont Virginia National South Carolina Wyoming Mississippi West Virginia Pennsylvania New Jersey Arizona Minnesota Louisiana Oregon Arkansas South Dakota Alabama Missouri Georgia Kentucky New York Wisconsin Michigan North Dakota Hawaii Rhode Island Oklahoma Florida Ohio 19 Source: FFY 2013 CMS-416 reports, Line 1b, 12d Note: Data reflects updates as of 10/22/14.
Medicaid Oral Health Learning Collaboratives WA ME OR NV CA AK ID AZ UT MT WY CO NM HI ND SD NE KS OK TX MN WI IA MO AR LA IL MS NY MI PA OH IN WV VA KY NC TN SC GA AL FL VT NH MA CT NJ DE MD D.C. RI Center for Health Care Strategies (funded by DentaQuest Foundation) CMS Learning Collaborative 20
CMS Learning Labs Quarterly technical assistance webinars, targeted primarily to state Medicaid programs but open to all Successful Beneficiary Outreach Strategies 21 Quality Improvement Processes: An Introduction for Medicaid and CHIP Dental Programs Engaging More General Dentists to Care for Young Children: Access to Baby and Child Dentistry (ABCD) in Washington and South Dakota Dental Sealants: An Effective State Strategy to Prevent Dental Caries in Children State Medicaid and CHIP Program Support of Sustainable Oral Health Care Delivery Models in Schools and Community-Based Settings Building a Partnership Between Medicaid and Head Start: the Pennsylvania Model
Successful Approaches in Other States Washington State: Access to Baby and Child Dentistry North Carolina: Into the Mouths of Babes Texas and Virginia: Preventistry New Hampshire: Partnership with WIC Iowa: I-Smiles http://www.medicaid.gov/medicaid-chip-program-information/by- Topics/Benefits/Downloads/Keep-Kids-Smiling.pdf 22
Insure Kids Now Dental Provider Locator 23 Download the Widget: http://datawarehouse.hrsa.gov/tools/widgets.aspx Use the Dental Provider Locator Tool: Go here http://www.insurekidsnow.gov/state/index.html then click on your state
Think Teeth! Three free materials: For babies and toddlers up to age 3 For children of all ages For pregnant women English/Spanish Can be bulk-ordered for free from CMS 24 http://www.insurekidsnow.gov/professionals/dental/index.html
Contact Patrick W. Finnerty pwfinnerty@aol.com 804-929-3318 25