PEDIATRIC PERFORMANCE MEASUREMENT: FLORIDA'S EXPERIENCES WITH CHIPRA External Quality Review Quarterly Meeting May 22, 2013Caprice Knapp, PhD

QUALITY OF CARE IN PEDIATRICS 2011 IOM report “Child Health

and Child Health Outcomes”

Health care expenditures are high (17% GDP), & outcomes are sub-par (Infant Mortality, Preventive Care)

Quality for the past 30 years has been primarily focused on adult and inpatient measures

CHILD HEALTH QUALITY IS FINALLY IN THE SPOTLIGHT! ACA

National Quality Strategy Medicaid Pediatric Rate Increase

CHIPRA - 24 core pediatric measures

Reauthorization of CHIP - increased reporting

• Each increases accountability, reporting, and places an emphasis on quality measures

• Expect more emphasis on reporting and quality improvement in the future (MOC, etc)

CHILDREN’S HEALTH INSURANCE PROGRAM REAUTHORIZATION ACT (CHIPRA)

GOALS OF CHIPRA Development of a core set of measures Creation of new measures Create an EHR format for children Provider-based initiatives (stay tuned….) Authorization of $20M to the Census Bureau

to improve child-specific population estimates

Streamline enrollment

24 CORE CHIPRA MEASURES Measure selection process Stakeholders: NQF, NCQA, AAP, AHRQ,

NICHQ, etc. Based on administrative, hybrid,

registry, and survey data Benchmarks do not exist 18 states are participating in Part A Noticeable gaps- mental health,

substance abuse, end of life, disparities In 2011, Florida reported on 20/24 In 2012, Florida reported on 22/24

DATA SOURCES FOR MEASURE CALCULATION – 2012

2012 DASHBOARD

Prevention and Health Promotion There are 13 preventive and health promotion measures. As compared to national benchmarks, Florida’s performance

is strong and slightly below the benchmark.

Management of Acute Conditions There are three measures that assess management of acute

conditions. Florida has more room for improvement on these measures

as compared to the others. Dashboard Key

Benchmark Performance

Management of Chronic Conditions Of the three measures that assess the management of

chronic conditions, Florida has average performance that is slightly below national benchmarks.

Family Expectations of Care

Florida has the strongest performance in the family expectations of care measures. Results are roughly equal to the national benchmarks.

Dashboard Key

Benchmark Performance

POTENTIAL MEASURES FOR IMPROVEMENT

Prenatal Care

Immunizations

Developmental

Screening

Ambulatory Care

Dental Care

Frequency of on going prenatal care (FPC)

Childhood Immunization Status (CIS) Combo 3

Development screening in the first 3 years of life

Preventive dental services

Timeliness of prenatal care (PPC)

Emergency department visits

Areas Measures

Dental treatments

HEDIS ADMINISTRATIVE MEASURES 2012

HEDIS ADMINISTRATIVE MEASURES Florida Met

Children and Adolescents’ Access to Primary Care Practitioners: Members 12 months to 25 months of age (CAP)

Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Continuation and Maintenance Phase

Follow-Up Care for Children Prescribed ADHD Medication (ADD) – Initiation Phase

Florida Did Not Meet Chlamydia Screening (CHL) Children and Adolescents’ Access to Primary Care

Practitioners: Members 25 months to 6 years of age (CAP)

Children and Adolescents’ Access to Primary Care Practitioners: Members 7 to 11years of age (CAP)

Children and Adolescents’ Access to Primary Care Practitioners: Members 12 to 19 years of age (CAP)

Follow-Up After Hospitalization for Mental Illness (FUH) Appropriate Testing for Children With Pharyngitis (CWP) Ambulatory Care: Emergency Department Visits (AMB)

APPROPRIATE TESTING FOR CHILDREN WITH PHARYNGITIS (CWP): BY PROGRAM TYPE

TXIX CMSN TXIX FFS TXIX PCCM TXIX HP TXXI MediKids TXXI Healthy Kids

0%

20%

40%

60%

80%

100%

60.5%51.6% 55.5% 60.4% 66.3% 67.0%

Rate

Title XIX Title XXI

Benchmark: 65.5%

3.4% 3.3% 6.2% 7.0% 6.6% 4.8%

11.1% 4.9% 3.6% 11.2%

FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION (ADD)- INITIATION PHASE BY PROGRAM

TXIX FFS TXIX PCCM TXIX HP TXXI Healthy Kids0%

20%

40%

60%

80%

100%

29.0%36.8% 41.5% 36.6%

Rate

Title XIX Title XXI

Benchmark: 35.7%

13.5% 5.9% 18.1%

FOLLOW-UP CARE FOR CHILDREN PRESCRIBED ADHD MEDICATION (ADD): CONTINUATION AND MAINTENANCE PHASE BY PROGRAM

TXIX FFS TXIX HP TXXI Healthy Kids0%

20%

40%

60%

80%

100%

27.7%

53.5%38.6%

Rate

Title XIX Title XXI

Benchmark: 42.1%

NON-HEDIS ADMINISTRATIVE MEASURES 2012

NON-HEDIS ADMINISTRATIVE MEASURES These Measures Include:

Total Eligibles Who Received Preventive Dental Services

Total Eligibles Who Received Dental Treatment Services

Annual Number of Asthma Patients with ≥ 1 Asthma-Related Emergency Room Visit

0.9% 0.3% 0.3% 0.8% 0.1%

NUMBER OF ASTHMA PATIENTS WITH ≥1 ASTHMA-RELATED EMERGENCY ROOM VISIT: BY PROGRAM TYPE

TXIX CMSN TXIX FFS TXIX PCCM TXXI MediKids TXXI Healthy Kids

0%

20%

40%

60%

80%

100%

10.2% 13.9% 10.7% 9.6% 5.7%

Rate

Title XIX Title XXI

OPTIONAL HYBRID MEASURES 2012

OPTIONAL HYBRID MEASURES Florida Did Meet:

Well-Child Visits in the First 15 Months of Life (W15)

Florida Did Not Meet: Prenatal and Postpartum Care: Timeliness

of Prenatal Care (PPC) Frequency of Ongoing Prenatal Care (FPC) Weight Assessment and Counseling for

Nutrition and Physical Activity for Children and Adolescents: Body Mass Index for Children/Adolescents (WCC)

Well-Child Visits in the 3rd, 4th, 5th and 6th Years of Life (W34)

Adolescent Well-Care Visits (AWC)

0.2% 0.3% 1.3% 0.9% 0.3%

WELL-CHILD VISITS IN THE 3RD, 4TH, 5TH

AND 6TH YEARS OF LIFE (W34) BY PROGRAM

TXIX CMSN TXIX PCCM TXIX HP TXXI MediKids TXXI Healthy Kids0%

20%

40%

60%

80%

100%

77.0% 75.3% 75.7% 74.4%62.8%

Rate

Title XIX Title XXI

Benchmark: 71.8%

1.8% 1.3% 3.5% 0.7%

ADOLESCENT WELL-CARE VISITS (AWC) BY PROGRAM

TXIX CMSN TXIX PCCM TXIX HP TXXI Healthy Kids0%

20%

40%

60%

80%

100%

58.7%49.8% 48.1% 53.8%

Rate

Title XIX Title XXI

Benchmark: 46.8%

REGISTRY MEASURES 2012

REGISTRY MEASURES These Measures Include:

Percentage of Live Births Weighing Less than 2,500 grams

Cesarean Rate for Nulliparous Singleton Vertex

Childhood Immunization Status (CIS)*

Immunization for Adolescents (IMA)*

*Discussed on slide “What’s New in 2012?”

CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS) 2012

COMPOSITES THAT FLORIDA HAS MET NATIONAL BENCHMARKS How Well Child’s Doctor

Communicates Customer Service Getting Needed Information Overall Ratings for Child’s Personal

Doctor Overall Ratings for Child’s

Specialist Overall Ratings for Child’s Health

Care Overall Ratings for Child’s Health

Plan

COMPOSITES THAT FLORIDA HAS NOT MET NATIONAL BENCHMARKS Getting Needed Care Getting Care Quickly Shared Decision Making Getting Specialized Services Coordination of Care and Services Personal Doctor Who Knows Child Getting Prescription Medicine

WHAT WAS NEW IN 2012? Improvements in the registry measures

Using FL SHOTS data greatly increased compliance for all three Immunizations for Adolescents submeasures for FHKC enrollees.

HYBRID MEASURE ANNUAL PEDIATRIC HEMOGLOBIN (HBA1C) TESTING AND CONTROL Comparison of results of administrative and

hybrid method

WHAT’S NEW IN 2013? Three new quality measures

Human Papillomavirus (HPV) Vaccine for Female Adolescents

Medication Management for People with Asthma Behavioral Health Risk Assessment for Pregnant

Women* Two retired measures

Otitis Media with Effusion – Avoidance of Inappropriate Systemic Antimicrobials in Children

CLASBI Florida will report 24/25 measures

SUMMARY Quality measurement is here to stay Measurement is not enough, the last

2 years of the CHIPRA grant will begin to focus on dissemination of information and ultimately, improvement.

What you do for Medicaid and CHIP enrollees matters!

THOSE WHO SAY IT CANNOT BE DONE SHOULD NOT INTERRUPT THE PERSON DOING IT.

-Chinese Proverb

CONTACT INFORMATION:The Institute for Child Health

Policy at the University of Florida

www. ichp.ufl.edu

Caprice Knapp, PhDcaprice1@ufl.edu