Download PIP Check-In #3 Follow-Up

PIP Check-In #3 Follow-Up
Improving Timeliness of Prenatal Care & WellChild Visits in First 15 months (6+ visits)
Summary of Findings: Best Practices and Recommendations
Janicka D. Harris, MPH
Government Analyst II
Bureau of Medicaid Quality
Clinical Quality Review and Initiatives Unit
Agency for Health Care Administration
Best Practice Categories
Pay for Performance
Programs
• Provider
incentive/bonus
Member Rewards
OB Educational
Webinars
Care Management for
Homeless members
Social Determinants of
Health
Utilization of Provider
Network Verification
(PNV) Portal
• SMMC Panel Roster
• Includes “pregnancy
indicator”
Health Literacy Programs
• Apply CLAS Standards
• Implement Cultural
Competency Plan
Medical Record Reviews
• Identify/capture
missing records from
providers
• Reduce care gaps
Cutting Edge
Practice
Emerging Practice
Community
Engagement
• Clinic Days
• Baby Showers
Data Enrichment
Programs
• Update member
contact
information
• Collaborate with
United States
Postal Service
(USPS)
Promising
Practice
Utilization of
Text4Baby
•
Evidence-based
texting to moms 3x
per week
Interim HEDIS
measure tracking
Employ Motivational
Interviewing
Approach
Community Connector
& Home Doctor
Programs
• Certified Community
Health Workers
• Home Visits
• High-risk members
Best Practice
Best Practices model adapted from the Association of Maternal and Child Health Programs (AMCHP)
Cutting Edge Initiatives
Include social determinants of health
questions to identify member needs to
link them community and social services.
Assess disparities in various programs
(e.g., prenatal care, child vaccinations).
Health
Literacy
Programs
Apply CLAS Standards in programs
or interventions; and implement
Cultural Competency Plan into
practice; and effectively promote
the importance of preventive and
medical programs.
Social
Determinants
of Health
Members with limited housing and
poor living conditions. Care is
provided for moms and their
babies to get the needed services.
Maternal,
Perinatal,
Well-Child
Programs
Care
Management
for Homeless
Members
Emerging Practices
Provider
Webinars
Data file includes the “pregnancy
indicator” and daily PCP and member
information for early identification of
enrollees.
PNV Panel
Roster
Report/
Newborn File
Trainings on billing/coding, referral
process, the benefits of family planning
waiver, and Healthy Behaviors Programs.
Offer CEU/CME credits to encourage
provider participation.
Maternal,
Perinatal,
Well-Child
Programs
Medical
Record
Reviews
Identify/capture missing records
from health care providers to
help with reducing care gaps and
providing needed services to
members.
Promising Practices
Provider
Incentives
Data
Enrichment
Programs
Maternal,
Perinatal,
Well-Child
Programs
Maintain updated member contact
information and ability to apply GIS
mapping/geo-coding. Contract with
external vendors (e.g., USPS, Optum,
Silverlink, Voxiva, Text4Baby).
Community
Engagement
Ex. Receive $100 when you
perform the first prenatal visit
in the 1st trimester and use
the appropriate billing codes.
Member
Rewards
Ex. Earn up to $50 for
attending 6 or more
prenatal care visits.
Ex. Host regional or
community baby showers,
clinic days, health and
fitness fairs.
Best Practices
Evidence-based counseling style where
providers become a helper in the change
process and express acceptance of your
member. Ex., for lifestyle change,
substance using members, and other
therapeutic approaches.
Employ
Motivational
Interviewing
Approach
Application sends evidencebased text messages to moms
3x/week timed to throughout
the course of their pregnancy.
Interim HEDIS
measures
Maternal,
Perinatal, WellChild Programs
Utilization of
Text4Baby
Track HEDIS/HEDIS-like measures
on a frequent basis for evaluation
purposes and to identify gaps in
care to prioritize members for
outreach.
Community
Connector/
Rapid
Response
Programs
Use certified Community Health
Workers to conduct EPSDT and
Prenatal Care outreach & home
visiting for non-compliant or hard to
reach members (e.g., children, highrisk pregnant women).
Recommendations
•
•
•
•
•
Educate your providers on proper coding
and billing for family planning, prenatal,
postpartum/inter-conception, and wellchild care.
Engage fathers or significant others in
PRE, postpartum, and W15 care.
Apply GIS mapping/geo-coding to locate
members with gaps in care and
implement home visiting interventions.
Have providers integrate the plan’s
Health Risk Assessment and Healthy
Behaviors Program forms into their EHR
systems.
– One Key Question™ Pregnancy
Intention Screening Questionnaire
Improve care coordination with local
Healthy Start Coalitions.
•
•
•
Encourage providers to screen for
perinatal anxiety, depression, BMI,
substance use, and tobacco use.
Have at least five data points to show an
improvement in the comprehensive
maternal and infant health (MIH)
measures and indicators for internal
program evaluation
– Program Participation
– Low Birth Weight
– C-section
– Pre-term Birth
– Family Planning (e.g., contraceptive
use, service availability by provider
type)
Inform pregnant members about the 1115
Family Planning Waiver Program during
1st and 2nd trimester.
WHAT’S NEXT?
PIP Check-In #4!
• Continue our focus on Improving Timeliness of Prenatal Care and
W15
• Identify what plans have considered/incorporated from the PIP CheckIn Team Recommendations
• Assess the progress of interventions post PIP Check-In #3, given any
modifications or enhancements
• Think about innovative strategies to integrate behavioral health in
MIH.
• Address other evidence-based approaches to the improvement of
comprehensive maternal and infant health outcomes.
Resources
Screening Forms/
Tools
ONE KEY QUESTION™ Pregnancy Intention (adapted from Oregon Foundation for
Reproductive Health) – Download PDF
WHO Medical Eligibility Criteria Wheel, 2015
http://srhr.org/mecwheel/
LARC and the Office of Population Affairs Contraceptive Care Measures
Hosted by the American College of Obstetricians and Gynecologists
March 16, 3-4 p.m. ET
Register Here
Upcoming
Webinars
Expanding Contraceptive Access: Developing and Implementing State-based
Approaches
Hosted by the American College of Obstetricians and Gynecologists
March 16, 1-2:30 p.m. ET
Hear presentations from both Mississippi and Oregon
Register Here
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Questions/Comments?
Janicka D. Harris, MPH
Government Analyst II
Bureau of Medicaid Quality
Clinical Quality Review and Initiatives Unit
Agency for Health Care Administration
[email protected]
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