Integrating Oral Health into Primary Care: Maine
Maine was a partner with Vermont, the lead awardee of a Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration grant, to identify strategies for improving the quality of health care for children enrolled in Medicaid and Children's Health Insurance Program (CHIP). One goal of Maine’s project was to strengthen the quality of and access to children’s health care through a variety of health care delivery models, provider and patient-level interventions, and measurement approaches. Maine chose to focus one part of its grant activity on integrating oral health into well-child visits for children under age 4. Through a partnership with From the First Tooth, primary care practices were recruited to participate in the project.
The project positively impacted performance statewide. From federal fiscal year (FFY) 2013 to 2014 the percentage of children in MaineCare ages 1 to 5 receiving an oral health service from a physician increased from 19.1% to 26.7%; in the same age group the percentage of children with a dental visit increased from 32.9% to 33.1%, and the percentage of children under 1 who received a dental visit almost tripled, from 3.3% to 8.5%. Maine’s experience adds support to the idea that increasing the level of oral health services provided during well-child check-ups will improve the chances of a child having a dental visit.
To achieve these results, clinicians in participating practices received information about reimbursement available for oral health risk assessments, training on the application of fluoride varnish, coaching on integrating oral health activities into office workflow and electronic medical record tracking, and opportunities to connect with local dentists willing to see young children (Dining with the Dentists). The clinicians then modified their well-child visit protocols to include oral health risk assessments, fluoride varnish, oral health prevention topics, and referral to a dental home.
Results were encouraging at the practice level as well. Practices with electronic health records quadrupled the number of children with a documented caries risk assessment while practices with paper charts almost doubled their rate. Practices also significantly increased the proportion of well-child visits during which oral health education topics were covered (rate of improvement varied by topic), and doubled the proportion of children with a documented dental home.
CHIPRA Quality Demonstration Grants: Webinar Series
Webinar on Improving Medicaid and CHIP Quality for Children
Join and the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) on February 11 at 2:00 p.m. ET for the free webinar, “Amplify Your Impact on Child Health Quality: Learning from the CHIPRA Quality Demonstration Grant Program.”
Speakers will highlight promising practices and key lessons learned from the 5-year grant program to improve health care quality for children in Medicaid and CHIP. You will also hear about an exciting new opportunity for technical assistance and peer-to-peer learning aimed at states that did not participate in the CHIPRA demonstration so they may benefit from the experiences of the 18 state grantees.
- Supporting primary care practice quality improvement and transformation.
- Improving service systems for youth with serious emotional disorders.
- Enhancing states’ capacity to report quality measures to providers, families, and stakeholders and promote their use.
- Building partnerships and capacity to leverage and sustain ongoing quality improvement.
If you are unable to get to a computer, you can access the audio portion of the webinar by calling: 1-844-396-8222. Use the same Session Number: 645 331 381.
Over the past four years, the Center for Medicaid and CHIP Services has worked with 18 states participating in the CHIPRA Quality Demonstration grant program. The goal of this grant program is to strengthen the quality of and access to children’s health care through a variety of health care delivery models, provider and patient-level interventions, and measurement approaches. Over the summer and fall of 2013 CMS conducted a five-part webinar series to share early findings from the CHIPRA Quality Demonstration Grants.
Webinar 1: Overview of CHIPRA Quality Demonstration Grant Program & Evaluation
CMS is funding and partnering with the Agency for Healthcare Research and Quality to conduct an evaluation of the grant program. In this webinar, the evaluation team, led by Mathematica Policy and Research Inc., provided an overview of the CHIPRA Quality Demonstration Grants, including how the grantees’ innovative work can be applied across populations and health care settings. (Presentation Slides)
Webinar 2: Leveraging Patient-Centered Medical Homes in CHIPRA Quality Demonstration Grants
Idaho, Massachusetts, North Carolina, and Utah are implementing Patient-Centered Medical Homes (PCMH) models designed to improve care coordination and health care quality for children in Medicaid and CHIP. In this webinar, grantees described how their PCMHs are leading to enhanced care for children and youth with special health care needs and to improved performance rates on the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. (Presentation Slides)
Webinar 3: Engaging Stakeholders in Improving Children’s Health Through the CHIPRA Quality Demonstration Grants
Oregon, South Carolina, and Vermont are connecting providers, families, and patients in order to build broad-ranging support for their practice-level quality improvement projects. In this webinar, grantees described how they are using learning collaboratives and the National Improvement Partnership Network (NIPN) as quality improvement tools. (Presentation Slides)
Webinar 4: Improving Behavioral Health Care Quality for Children and Adolescents
Three grantees across six states (Colorado, Georgia, Maryland, New Mexico, Pennsylvania, and Wyoming) are improving how behavioral health is delivered to children in Medicaid and CHIP. In this webinar, grantees described how they are improving children’s access to high-quality behavioral health care through the use of school-based health centers, care management entities, and health information technology. (Presentation Slides)
Webinar 5: Using Health Information Technology to Support Child Health Quality
CMS, in partnership with the Agency for Healthcare Research and Quality (AHRQ), released a children’s electronic health record format in February 2013. In this webinar, North Carolina and Pennsylvania discussed their efforts to test the use of the children’s electronic health record format. Illinois, a grantee partner state to Florida, described how it is using health information technology to improve prenatal care data and to support providers in improving child health quality. (Presentation Slides)
- North Carolina
- South Carolina
|Partner State(s):||New Mexico|
Sandeep Wadhwa, M.D
The State of Colorado, in partnership with New Mexico, will receive $1,722,161 for the first year of the five year grant that will total $7,784,030. Colorado and New Mexico will form an Interstate Alliance of School-Based Health Centers (SBHCs) to integrate school-based health care into a medical home approach to improve the health care of underserved school-aged children and adolescents. Colorado and New Mexico also plan to utilize SBHCs to improve the delivery of care within the school setting and to improve screening, preventive services, and management of chronic conditions. The goal will also be to educate adolescents to encourage more involvement in their own health care, and follow-up with primary care providers. The demonstration will also focus on the integration of mental health with primary care.
Florida, in partnership with the State of Illinois will receive $880,371 for the first year of the five year grant that will total $11,277,361. The two States will test collection and reporting of recommended and selected supplemental measures of children’s health quality, using existing data sources and improved data sharing. The two States will also work to ensure that ongoing Statewide health information exchange and health information technology efforts support the achievement of child health quality objectives and to enhance the development of provider-based systems of care that incorporate practice redesign and strong referral and coordination networks, particularly for children with special health care needs. Florida and Illinois will also work to support collaborative quality improvement projects to improve birth outcomes across the two States.
Maine, in partnership with the State of Vermont will receive $2,030,721 for the first year of a five year grant that will total $11,277,362. The State of Maine plans to test, develop and expand the use of evidence-based child performance measures. In addition, Maine and Vermont will be able to expand their information technology systems in order to improve the exchange of child health data and expedite the provision of services to children in foster care. The two States will also test and evaluate a pediatric medical home model that will test the impact of changes in payment reform, implementation of consensus practice guidelines, and provider education on child health outcomes. In particular, Vermont will build upon its leadership role as convener of the National Improvement Partnership Network to increase the number of participating States, particularly States that are not part of this grant program.
|Partner State(s):||Georgia, Wyoming|
Al Zachik, M.D.
The State of Maryland, in partnership with Georgia and Wyoming, will receive $2,401,467 for the first year of a five year grant totaling $10,993,171. The three States are committed to improving the health and social outcomes for children with serious behavioral health needs. The grant will be used to implement and/or expand a Care Management Entity (CME) provider model to improve the quality and better control the cost of care for children with serious behavioral health challenges who are enrolled in Medicaid or the Children’s Health Insurance Program. The CME will incorporate wrap-around services, peer supports, and intensive care coordination. The participating States will utilize the CME model to improve access to appropriate services, and employ health information technology to support clinical decision making. The model will also be designed to reduce unnecessary use of costly services, improve clinical and functional outcomes for children and youth with serious behavioral health needs, and involve youth and their families in care decisions.
Massachusetts will receive $1,496,542 for the first year of the five year grant that will total $8,777,542. The State will work with the University of Massachusetts Medical School, the Children’s Hospital of Boston, the Massachusetts Health Quality Partners, and the National Initiative for Children’s Healthcare Quality to apply and evaluate recommended measures of children’s health care quality and to make comparative quality performance information available to providers, families, and policymakers. The State will also use learning collaboratives and practice coaches to support the process of transforming pediatric practices into medical homes that provide family and child-oriented care, measure and improve that care, and enhance outcomes, particularly for children with targeted conditions: Attention Deficit and Hyperactivity Disorder, asthma, and childhood obesity.
|Lead State:||North Carolina|
Dr. Craigan Gray
The State of North Carolina will receive $2,210,712 for the first year of the five year grant that will total $9,277,361. The State agency will be working with the State’s Academy of Family Physicians, the State Pediatric Society, and Community Care of North Carolina to build on a strong public-private partnership that has documented successes in quality improvement, efficiency and cost-effectiveness of care for more than 12 years. This grant will implement and evaluate the use of recommended quality measures and strengthen the medical home for children with special health care needs by testing and evaluating three provider-led community-based models. These models will be used to identify, treat, and coordinate care for children with special health care needs, particularly children with developmental, behavioral, and/or mental health disorders North Carolina has also agreed to be one of two States implementing a model electronic health record format for children.
|Partner State(s):||Alaska and West Virginia|
Dr. Charles Gallia
Oregon, in partnership with Alaska and West Virginia, will receive $2,231,890 for the first year of a five year grant that will total $11,277,361. The demonstration will test the combined impact of patient-centered care delivery models and health information technology in improving the quality of children’s health care. The three States will work together to develop and validate quality measures, improve infrastructure for electronic or personal health records utilizing health information exchanges, and implement and evaluate medical home and care coordination models. Oregon, Alaska and West Virginia share the demographic quality of having a large proportion of their populations residing in rural areas that are disproportionately low-income.
Pennsylvania will partner with several medical centers and hospitals in the State to execute this demonstration. The State will receive $1,934,754 for the first year of the five year grant that will total $9,777,361. Pennsylvania will test and report on recommended pediatric quality measures and promote the use of health information technology in health care delivery to maximize the early identification of children with developmental delay, behavioral health issues, and those with complex medical conditions. This will facilitate coordination of care with the primary care practitioner medical home, medical specialists, and child-serving social service agencies. A pre-clinic visit assessment is expected to enhance communication between providers and patients, and an electronic tracking system will link children with special needs to appropriate services. Pennsylvania has also agreed to be one of two States implementing a model electronic health record format for children.
|Lead State:||South Carolina|
South Carolina Department of Health and Human Services
South Carolina will receive $2,214,263 for the first year of the five year grant that will total $9,277,361. South Carolina plans to build a quality improvement infrastructure that enhances the ability of the State’s pediatric primary care practices to establish medical homes that effectively coordinate and integrate physical and mental health services. Health information technology will be used to gather, aggregate, and report on outcomes data to support the provision of evidence-based care and allow peer-to-peer comparisons. The State will automate data collection of, and feedback on, recommended child health quality indicators in 15 pilot practices. These practices will participate in learning collaboratives to disseminate knowledge, develop plans, assess success of implementation and adjust plans of action.
The State of Utah, in partnership with Idaho, will receive $2,877,134 for the first year of the five year grant that will total $10,277,360. Utah and Idaho will develop a regional quality system guided by the medical home model to enable and assure ongoing improvement in the healthcare of children enrolled in Medicaid and CHIP programs. The project will focus on improving health outcomes for children and youth with special health care needs through the use electronic health records, health information exchanges, and other health information technology tools. The States plan to pilot a new administrative service using Medical Home Coordinators embedded in primary and sub-specialty care practices to support ongoing improvements in care, coordination of care, and support for children with chronic and complex conditions and their families. Utah and Idaho also plan to use learning collaboratives, practice coaches, and parent partners to train primary and sub-specialty child health practices in medical home concepts. The ultimate outcome will be improved health care for children in the two States, robust integration of health information technology into child health practices, and a regional quality system and valuable quality improvement tools and resources that can be shared with other States and regions.