1. Making a Difference for Children Across North Carolina

2. CHIPRA CONNECT TEAM Dr. Marian Earls - Physician Champion Beth Glueck - Connect Project Manager Marla Satterfield - Clinical Coordinator James Green - CHIPRA Analyst Stacy Warren - CHIPRA Project Director

3. CONNECT Participants Sandhills Community Care Network Dr. Masoud Ahdieh ABC Pediatrics Sandhills Pediatrics Harnett County Health Department AccessCare Goldsboro Pediatrics Community Care Plan of Eastern Carolina Washington Pediatrics Pamlico Pediatrics Pitt County Public Health Northwest Community Care Network Surry County Health and Nutrition Center Kids Count Pediatrics Westgate Pediatrics Forsyth Pediatrics at Robin Hood

4. CHIPRA A Quality Demonstration Grant The CHIPRA statute mandates the ‘experimentation’ and ‘evaluation’ of several promising ideas related to improving the quality of children’s healthcare.

5. Needs of America’s Children American children experience worse health and higher levels of mortality than do children from most other developed nations and receive recommended care only 42% of the time UNICEF, The State of World’s Children, 2009 (visited April 10,2009 Mangione-Smith R, Decristofaro A, Setodji C, Keesey Jl, Adams The Quality of Care Received by Children and Adolescents in the US. Pediatric Academy Societies, E-PAS2006:59:4500.1

6. Medicaid Enrollees on the Rise In 2009, 60 million people were on Medicaid and over half of them were under 18. 1 in every 4 American children are on Medicaid Approximately 31% of NC children are on Medicaid www.statehealthfacts.orgwww.statehealthfacts.org 2008-2009

7. Centers for Medicare and Medicaid Services (CMS) CMS is committed to demonstrating improvement in Medicaid/CHIP systems through the synthesis of data and activities from diverse Medicaid/CHIP systems, providing Technical Assistance to States and tracking improvement using metrics. This includes addressing health care disparities, long term health care needs supports and services and builds on the synergy and coordination of efforts with public health agencies, education and mental health care systems to improve the health care outcomes for children.

8. CMS is also interested in utilizing the CHIPRA grants in part to further Early and Periodic Screening, Diagnostic and Treatment (EPSDT) These goals include improving access to, utilization of and reporting of services to which children are entitled under EPSDT in such areas as: Vision and Hearing Obesity Oral Health Behavioral Health

9. The Division Of Medical Assistance (DMA) awarded funding in three categories CHIPRA Categories A - Experiment with and evaluate the use of new and existing measures of quality for children B – promote the use of health information technology (HIT) for the delivery of care for children C – evaluate provider-based models to improve the delivery of care D – demonstrate the impact of model pediatric EHRs (electronic health records) E – creating targeted models to demonstrate their impact on health, quality and cost.

10. Category A Core Measures NC will use its Community Care infrastructure to implement and evaluate the use of the new set of 24 quality measures identified by AHRQ and CMS. NC will expand upon the current data collection system to incorporate the core set of children’s health measures and will work with local practices on the implementation, feedback and the meaningful use of the quality information for improvements in performance.

11. Category D - Pediatric Electronic Health Record Existing EHR systems often do not optimally support the provision of health care to children. The goal of Category D is to develop a model EHR Format for children, demonstrate that it can be readily used, and package it in a way that facilitates broad incorporation into EHR systems. Another purpose of this category is to evaluate the pediatric EHR format developed by AHRQ to assess the impact of the EHR on the quality and cost of children’s health care across the care continuum. NC, through its Community Care program, will work closely with the NC Regional Extension Center (REC) in the implementation of the model Electronic Health Record for Children (EHR). PEHR consultants in all 14 Networks will work with providers/medical homes interested in implementing the model PEHR. The elements of the PEHR will be evaluated and tested with grantee’s input during the planning and infrastructure development phase for its impact on quality of care and healthcare costs.

12. Category C CHIPRA ‘Connect’ NC will strengthen the medical home for children and youth with special health care needs (CYSHCN) by testing and evaluating provider-led, community-based models that will identify, treat and coordinate the care of CYSHCN, particularly children with developmental, behavioral and /or mental health disorders

13. CHIPRA CONNECT OBJECTIVES Our objectives for CHIPRA CONNECT: to demonstrate that a provider-based model of care to improve the quality of children’s health care, especially children with special health care needs, can be implemented to learn how best to implement provider-based models of care, and identify barriers and how they can be overcome, and to determine the impact of provider-based models of care on children’s health care quality specifically focusing on EPSDT, obesity, oral health and the integration of behavioral health.

14. WHY ‘CONNECT’ Collaboration with EPSDT, ABCD and NCCCN’s Informatics Center to collect quarterly data and feedback to the practices for quality improvement projects Collaboration with the behavioral health integration program with NCCCN Collaborate with the Carolina Dental Home (CDH) Operations Committee regarding Oral Health

15. CHIPRA CONNECT PROJECT Learning Collaborative for Cohort I begins PCMH Certification Medical Home 2015 2014 2013 2012 2011 Learning Collaborative for Cohort II begins Obesity Oral Health PCP Pre-Work Mental Health Toolkit Obesity Oral Health Risk Stratification Tool

16. Moving Forward Hiring of a full time Quality Improvement Specialist dedicated to Pediatrics and the CONNECT project Participating in monthly calls Participating in bi-annual day trainings Monthly Rolling Chart Audits (completed by the QI specialist) Utilizing the Technical Assistance provided by ICARE

17. Connect Learning Collaborative What’s Coming? Monthly Calls When: Second Friday of each month Time 12:00pm-1:00pm Bi-Annual Meetings/Trainings When: Second Friday of each month Time: 10:00am to 3:00pm Example Topics Motivational Interviewing Risk Stratification Tool Obesity Oral Health Pediatric EHR format Secondary Screens PCMH (certification) Cultural Competence

18. Integration of Categories A, C, and D Each strategy will propel quality improvement both independently and in concert with the other strategies A Quality Measures C Medical Home Measures enable ongoing, flexible tracking of Medical Home Impact Medical Homes provide data on feasibility, cost and value of measures EHR supports Medical Home implement quality care EHR enables will enable efficiencies and timely tracking and meaningful use of quality measures Measures inform and evaluate impact of EHR Medical Homes will drive service-oriented, quality EHR development D Pediatric Electronic Health Record

19. In summary….. It’s about improving access and quality for children!