“Next Steps for ME CHIP” Maine Child Health Improvement Partnership (ME CHIP) Advisory Group...

“Next Steps for ME CHIP”

Maine Child Health Improvement Partnership (ME CHIP) Advisory Group

Friday, February 13, 2015, 12-2 pm at QC

ME CHIP and the First STEPS Learning Initiative is part of the Maine Improving Health Outcomes for Children demonstration grant awarded by the Centers for Medicare and Medicaid Services to MaineCare in partnership with the Maine Center for

Disease Control and Prevention, the Muskie School of Public Service at the University of Southern Maine, Vermont’s Medicaid Program, and the University of Vermont.

Maine Quality Counts, Webinar/Phone AvailableWebinar: www.readytalk.com 5493654

Audio: 866.740.1260, Access Code: 5493654#

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http://www.readytalk.com/

Maine Child Health Improvement Partnership (ME CHIP)Mission

To optimize the health of Maine children by initiating and

supporting measurement-based efforts to

enhance child health care by fostering public/private

partnerships.

Vision

All practices providing health care to children will have the

skills, support, and opportunities

for collaborative learning needed to deliver high quality

health care.

ME CHIP Meeting 2/13/15 2

ME CHIP is part of the National Improvement Partnership Network (NIPN)

ME CHIP Agenda

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12:00 Welcome and review minutes 12:05 Input on strategic priorities/MOC12:25 Input on potential future work on

Adolescent Medicine 1:05 Follow-up on PTE from December1:15 Planning for Dr. Garner’s visit 1:45 Next STEPS2:00 Adjourn

ME CHIP Meeting 2/13/15

ME CHIP Participants

4ME CHIP Meeting 2/13/15

Amy Belisle, MD Director, Child Health Quality Improvement Maine Quality Counts x

Sue Butts-Dion First STEPS Manager/Quality Specialist Maine Quality Counts x

Kyra Chamberlain, MS, RN IHOC Project Manager Muskie School of Public Service x

Nancy Cronin Executive Director Maine Development Disabilities Council x

Deb Deatrick VP MaineHealth x

Donna Gartland Clinical Quality Program Manager Martin’s Point Health Care

Deb Gilbert QC for Kids Administrative Coordinator Maine Quality Counts x

Lisa Letourneau, MD Executive Director Maine Quality Counts x

Donna Levi Program Manager MaineHealth x

Beth Pearce EPSDT Coordinator MaineCare x

Nan Simpson, LSW DSI Project Manager Maine Quality Counts x

Dee DeHaas Executive Director MAAP x

Pam Ford-Taylor x

Martha Elbaum Williamson IHOC Evaluation Team Muskie School of Public Service

Kevin Flaningan, MD Medical Director MaineCare

Kim Fox Evaluation Muskie School of Public Service

Anne Graham, NP State Representative House District #109 x

Sue Mackey-Andrews Health Accountability Team Maine Children’s Growth Council x

Lorrie Potvin PTE Program Director Maine Health Management Coalition x

(Mary)Lindsay Smith Research Analyst Muskie School of Public Service

Ginger Roberts-Scott MaineCare x

Discussion of What is Next for ME CHIP- Getting Your Input

• Review strategic priorities from March 2014• Are their gaps around children’s health care

that you have identified in the last year that we should be looking at as a group?• Ideas for future MOC projects• Relooking at ME CHIP Advisory Group

Structure- are we missing key stakeholders?


Prevention (Age 0-5)Lead/Anemia Screening

Oral Health of Young Children

Adolescent MedicineTeen Depression

Screening

Social Determinants of Health

Adverse Childhood Events

Care CoordinationTransitions

Drug Affected Infants

Structure/ProcessMetrics

Chronic CareAsthmaADHD

ME CHIP Priority Areas


Input on Planning Potential Future Work on Adolescent Medicine


• Identify overarching scope, goals, deliverables• Problem/issue being addressed• Aims statement• Goals• Deliverables• Scope• ID customers/stakeholders • Customer/stakeholder needs• Environmental scan• Integration/alignment w/ other programs• Constraints, risks

Input on Potential Future Work on Adolescent Medicine

• Potential Aim: Improve the health of Maine’s children and adolescents by increasing rates of the following by 10%:

• Vaccines by age 13 as recommended by the American College of Immunization Practices and the US CDC: Tdap (tetanus, diphtheria, pertussis); MCV (meningococcal disease); and HPV (human papillomavirus)

• Adolescent well visits • Teen depression and substance abuse screening


Baseline Data


Hospital Service Area In ME

Rate of Adolescent

Well Care Visits

Rate of Adolescent

Well Care Visits

Hospital Service Area In NH or VT

Portland, ME 44% 61% Manchester, NHBangor, ME 44% 55% Lebanon, NH

Lewiston, ME 43% 54% Nashua, NHAugusta, ME 36% 54% Dover, NH

50% Concord, NH 46% Burlington, VT

Table 1. Rates of Adolescent Well Care Visits Based on All Payer HEDIS Data 2007-2010 as Reported in the Dartmouth Atlas of Children’s Health Care of Northern New England[1]

[1] The Dartmouth Atlas of Children’s Health Care in Northern New England, December 2013, P. 32.

Baseline Data- Well Visits


Improving Health Outcomes for Children (IHOC) Summary of Pediatric Quality Measures For Children Enrolled in MaineCareFFY 2009-FFY 2013

Baseline Data

Immunization Type

2011 Baseline Rate

2013 Rate

Tdap 65.9% 80.4% (+13.8%)MCV 59.8% 78.9% (+18.5%)

HPV-girls 17% 23.3% (+5.9%)HPV-boys 5.6% 8.9% (+3.3%)


• As reported in 2014 American Health Rankings report, annual NIS data shows that: Adolescent immunizations (13-17 year old) rate increased from 59.5% to 65% in 2012 and to 66.7% in 2013.

• First STEPS Rates in 21 practices: 2011-2013Table 1. Adolescent Immunization Rates: First STEPS (2011-2013)(Based on 21 demonstration sites in ImmPact; age 13 measures)

[1] Not able to measure this rate at the beginning of the project; this baseline was determined as of December 2012

Baseline Data- Chlamydia Screening


Improving Health Outcomes for Children (IHOC) Summary of Pediatric Quality Measures For Children Enrolled in MaineCareFFY 2009-FFY 2013

What Baseline Data do you want to collect?


• Depression screening data• Substance Use screening

Potential Timeline• Planning – July-October 15• Recruit- Oct 15- Jan 2016• Initial ACES training- Oct/Nov 2015 with MRBN• Initial Immunization training 3 sites in Nov/Dec

by MH (Bangor, Augusta and one at another site; MH has done several trainings in Portland, Pen Bay and Biddeford areas)

• Learning Collaborative- 2 phases over 6-8 months starting in Spring 2016


Ideas for Topics


•Engagement strategies with adolescents and their families. •Social media•Community and school connections•Teen advisory groups •Assembling practice teams, school nurses, and families•Health screenings•Depression•Suicide risk screening•HPV and adolescent immunizations•Improving interactions and resilience•Substance use screening•Violence•Texting•Bullying•Sexual identity•Confidentiality

QI Needs for Project• “Strengths, Weaknesses, Opportunities, and Threats

(SWOT)” analysis using baseline immunizations data, the office systems survey results and team assessment results.

• Help with PDSA Cycles- test vs. task• Mapping out office workflows• On site vs virtual coaching- need for health system

support


Potential Partners


• MaineCare• MAAP, MAFP, MOA• CDS• School Nurses• Parents and teens• DOE• MaineHealth/Vax Maine Kids• Muskie• Health Systems• MRBN

Follow-up on PTE from December

–ME CHIP recommendations from December meeting will be presented to the February 26th PTE Clinical Steering group from 9-9:30


ME CHIP Recommendations to PTE on Immunizations

• Change Immunizations Ratings to Good > 45 Points, Better > 70 Points, Best > 90 Points

• Adjust individual measures points so that total points equal 100• Immunizations: Change to 3.25 points each measure (from

3.5)• Update first target to 2013 NIS Maine data – at 24 months and

update second target to 2013 Maine ImmPact data for First STEPS practices for 75th percentile

• Cap individual immunization rates at 94% (Maine kindergarten philosophical exemption rate is 5.1%)

• The ME CHIP vote in December 2014 is for recommendations for the PTE Clinician/Provider Steering Group. They will need to adopt changes and set timeline for when they go into effect.


ME CHIP recommendations to PTE on asthma

• Change Asthma Ratings to Good > 50 Points, Better > 70 Points, Best > 85 Points

• Asthma (Change to 13.5 for first 6 measures and keep 10 for BMI%); Change population based reporting for 9 points to mirror immunizations scoring

• PTE should thoroughly review asthma metrics in Summer 2015

• The vote in December was for recommendations for the PTE Clinician/Provider Steering Group. They will need to adopt changes and set timeline for when they go into effect.


Dr. Garner’s Visit- May 1st, 1-4 pm at Senator

How to incorporate early brain and child development and ACES into policy and QI work•Who is attending• Structure of Meeting- how to optimize

time•What do we want to leave with?• Action Plan


• 3 Community Pilots selected to work across early childhood sectors on developmental screening- first set of trainings completed; initial data due Feb 15th

1) Mid-Coast area 2) Waterville Area3) Bangor area

• Exploring ASQ online- way to link screenings across the sectors, EMRs, and parents can complete prior to visit online

• Next tri-Community training is May 6th

DSI Work in 2014-15: “Completing the Loop”


Next Steps


Future Meeting Dates• Future Meeting Dates (2nd Friday, alternating

in person at QC and by phone)-Friday, May 1, 2015, 1-4 with Dr. Garner at the Senator Inn, Augusta-Friday, June 12, 2015, 12-2 in person -Friday, August 14, 2015, 1-2 by phone-Friday, October 9, 2015, in person -Friday, December 11, 2015, 1-2 by phone


ME CHIP Contact Information

• Amy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, [email protected] / 207-847-3582

• Sue Butts-Dion, First STEPS Program Manager, Quality Specialist, Maine Quality Counts, [email protected] / 207-283-1560

• Deb Gilbert, QC for Kids Administrative Coordinator, [email protected] / 207-620-8526 x 1017


mailto:[email protected]



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