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ABCD for Oregon’s Healthy KidsOregon Division of Medical Assistance Programs
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ABCD and Oregon
Medicaid Managed Care Organizations (MCOs) care for nearly 1 in 3 Oregon children.
Use a project that mirrors a Performance Improvement Project (PIP) to leverage Medicaid’s Managed Care requirements.
Implement a process of community engagement in order to guide and inform the development of the PIP.
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One of the Optional EQRO Activities available to states (at 75% FFP) Validate encounter data Administer consumer & provider
surveys Validate consumer & provider
surveys Calculate of performance
measures Conduct of performance
improvement projects Conduct of focused studies on
quality
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Using CMS protocols as a road map
EQR must be conducted in a manner “consistent with” the protocols.
FFP at the 75 percent rate is available for expenditures for EQR activities
Find them at https://www.cms.gov/MedicaidCHIPQualPrac/07_Tools_Tips_and_Protocols.asp
The protocols are generic – latitude to customize to meet the goals of ABCD and your state.
You provide the tools to managed care Makes it easier to join your efforts
Get more details from CFR 42 § 438.310 - .370.
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10 Activities in the CMS PIP protocol1. Select the study topic(s) 2. Define the study question(s) 3. Select the study indicator(s) 4. Use a representative and generalizable study
population5. Use sound sampling techniques (if sampling is
used)6. Reliably collect data7. Implement intervention and improvement
strategies8. Analyze data and interpret study results9. Plan for “real” improvement10. Achieve sustained improvement
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Oregon’s Activities and Interventions• Community engagement to help
shape PIP• Parents (Community Cafés)• PCPs, EI staff, other stakeholders
(interviews)• All of the above (town hall forum)
• Learning collaboratives and quality improvement liaisons for managed care organizations (MCOs) to support PIP roll-out
• MCO baseline assessment tool to capture current practices, guidelines to providers
• Common referral form
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Implications: Learning from doing• Really connecting systems is > connecting
data, = people communicating• Being patient centered means doing the
reality check of parent and families- cafés provide that forum
• We are rebuilding our health care delivery system, first for Medicaid, then for public employees. The cafés help us understand the experience of getting care, what are parents’ expectations from a community perspective, and they do vary
• We are building into the redesigned organizations a primary emphasis on care coordination (e.g., Operationalizing CPT codes 99366-99368)
• We are rethinking early education as well
Oregon ABCD III Improvement Project www.oregon.gov/DHS/ph/ch/abcd.shtml Division of Medical Assistance ProgramsCharles Gallia, Ph.D. [email protected]
SPECIAL THANK to Colleen Reuland, CAHMI and OPIP and Sarah Wetherson
