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STRATEGIC DIRECTIONS: Key Informant Interviews with EPSDT Directors Peggy McManus MCH Policy Research Center July 12-13, 2005.

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Presentation on theme: "STRATEGIC DIRECTIONS: Key Informant Interviews with EPSDT Directors Peggy McManus MCH Policy Research Center July 12-13, 2005."— Presentation transcript:

1 STRATEGIC DIRECTIONS: Key Informant Interviews with EPSDT Directors Peggy McManus MCH Policy Research Center July 12-13, 2005

2 STRATEGIC DIRECTIONS STANDARDS & POLICIES Session Objectives: Examine state EPSDT policies for hearing screening & follow-up Compare with JCIH, AAP guidelines, & Healthy People 2010 objectives Consider strategies for updating state EPSDT policies on hearing

3 Interview Findings: Current Picture and Strategies EPSDT standards primarily based on AAP preventive care guidelines, with some variations EPSDT standards on hearing focus almost exclusively on screening, not referral & follow-up Unclear the extent to which EPSDT standards reflect JCIH guidelines

4 Standards & Policies: Interviews States have organized mechanisms for regularly updating EPSDT, with input from other state agencies & key stakeholder groups New standards & policies disseminated through provider manuals, bulletins, & newsletters Effective ways of implementing new standards -- work closely with state AAP chapters

5 Standards & Policies: Interviews Less involvement with AAFP, though states interested in more Hospital involvement critical State universal newborn hearing screening laws – key in facilitating adoption of standards Attention needed to address outreach, screening, & follow-up of failed screens.

6 Strategic Directions Information & Education Session Objectives: Share ideas about effective educational strategies for working with PCPs, families, hospitals, MCOs, and local health departments (LHDs) Examine potential opportunities for informing & involving key stakeholders

7 Information & Education: Interviews Primary Care Physicians: No magic bullets or single approaches Very little done so far on follow-up Important to have good, actionable data about how PCPs perform Evidence-based data also important Newsletters that profile promising practices useful

8 Information & Education: Interviews PCPs continued: Ongoing training of residents helps CME necessary, but not sufficient More needed to target PCPs in rural areas, with small numbers of children in practice

9 Information & Education: Interviews Families: -- Work with existing family networks -- More education is needed on follow-up, esp. with families whose children have complex health care needs -- Follow-up telephone calls & face-to-face meetings work best

10 Information & Education: Interviews Use of popular media helpful Critical to have a why piece – explaining why both screening & follow-up are necessary Informing families about standard of care is important and can positively influence parent demand for services

11 Information & Education: Interviews Hospitals State EHDI efforts, esp. involving on-site work, critical in implementing universal newborn hearing screening Funding hearing aid loaner program important Need to target small, rural hospitals and move beyond screening Perinatal conferences important Also, having short educational videos about hearing screening for use by hospitals important

12 Information & Education: Interviews Local Health Departments EPSDT outreach workers have critical role to play, but few have focused on hearing Important to link with home visiting, case management, disease mgmt., & other initiatives involving LHDs Regular training opportunities for LHDs, with CME important

13 Information & Education: Interviews Hard-to-reach groups EPSDT outreach workers have critical role to play Home visiting & case mgmt. programs reach high-risk groups, though hearing follow-up seldom addressed More attn. to cultural competence to reduce families delays in seeking follow-up Translation & transportation are critical

14 Information & Education: Interviews Overarching Comments Comprehensive strategy needed, promoted through various channels (e.g., immunization) Have a simple, consistent message – 1/3/6 Involve key groups at outset Address shortage of audiologists, incl. causes – education & training, reimbursement, other Streamline & integrate hearing follow-up services with CM, EI, WIC, #, EPSDT outreach, etc

15 Strategic Directions: Quality & Financial Incentives Session Objectives Review potential opportunities for incorporating national benchmarks from Healthy People 2010 Examine Medicaid reimbursement levels for hearing services Consider alternative performance incentive strategies

16 Quality Incentives: Interviews Few EPSDT programs use or are aware of Healthy People 2010 hearing objectives Most Medicaid quality standards from NCQA (HEDIS), AAP Use of quality indicators (e.g., 1/3/6) could be an effective strategy Important to have actionable data for use by providers Comparative state data also helpful

17 Quality Incentives: Interviews NICHQs model of collaborating with practices, conducting chart reviews, identifying improvement strategies, & providing feedback (eg, lead, immuniz) Need to make sure hearing screening & follow-up is incorporated into EPSDT evaluations. Records could be tagged for follow-up

18 Quality Incentives: Interviews Consider a GPRA project (e.g., immunization) CMS could set a standard (e.g., dental care) Maintain close link with public health Issue certificates of excellence to providers scoring 95% of higher Acknowledge the good work of providers Theyre not doing this work for the financial rewards, but for the benefits to children.

19 Reimbursement Incentives: Interviews Ha, ha, ha. Stand in line. State Medicaid and public health funding is already stretched to its limits Important to piggyback with existing EPSDT administrative outreach efforts Through Medicaids administrative match, possibly some potential for funding follow-up activities

20 Reimbursement Incentives: Interviews To claim administrative match requires financial support from other state agencies – good luck! To justify payment changes, evidence of cost savings needed Professional organizations & provider groups need to advocate for rate increases showing costs not being met and access adversely affected

21 Reimbursement Incentives: Interviews Also, comparative state fee data useful – no one wants to be lowest (see handouts) See examples from dental care. Also, incentives used successfully with EPSDT visit rates, immunizations, & lead screening Examine hospital payment mechanisms to assess where to place incentive Consider outside foundation & community funds

22 Strategic Directions: Monitoring & Tracking Session Objectives Examine existing state data sources and data- sharing arrangements to link with Consider ways to improve accuracy & quality of reportable data on hearing screening & follow-up

23 Monitoring & Tracking: Interviews Accurate data depends on accurate provider coding. Providers/office staff may need training on appropriate coding. When hearing services bundled into a single code or folded into DRG payments, difficult to rely on claims data Tracking hearing is much more complicated than lead screening

24 Monitoring & Tracking: Interviews Potential data sources: vital records, EPSDT, EHDI tracking system, early intervention, care management, hospital databases, administrative claims, case management systems, registries Data-sharing agreements most helpful Publish program success

25 Strategic Directions: Collaboration Session Objectives Identify new & existing opportunities to effectively promote collaboration among key stakeholders Share information about promising strategies Consider roles & responsibilities for state EHDI programs to play with Medicaid & participating MCOs and other providers

26 Collaboration: Interviews Already a great deal of collaboration between Medicaid and EHDI programs, mostly around newborn screening Meetings at least quarterly help, involving Medicaid & other key stakeholders Written interagency agreements useful in promoting accountability

27 Collaboration: Interviews Examples: MD – a portion of EHDI coordinators time/salary is dedicated to working with Medicaid. IL: Think Tank Day on newborn hearing projects for coming year; developed education, referral, & follow-up document; grand rounds training with AAP; newborn screening advisory group; now working on parent website

28 Collaboration: Interviews Linking with other screening programs, such as electronic birth certificates, immunizations, or newborn metabolic screening, may have potential but not yet done for most part State Early Childhood Comprehensive Systems (SECCS) grants important vehicles to link with in many states. Other initiatives – Healthy Babies/Healthy Kids& Families, Commonwealths ABCD program, & Early Education and Care

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