1. Performance Improvement Projects (PIPs): Agency Findings
Timeliness of Prenatal Care
Well-Child Visits in First 15 mos.
- Successes, Opportunities, and Sharing Best Practices -
External Quality Review Meeting Wednesday, November 2, 2016
Janicka D. Harris, MPH
Bureau of Medicaid Quality
Agency for Health Care Administration

2. Timeliness of Prenatal Care (PPC-Pre)
Increase the percentage of women who had a live birth baby that received a prenatal care visit as an enrollee of the managed care plan in the first trimester OR within 42 days of enrollment to achieve NCQA Quality Compass 75th percentile.
National Medicaid Rate
FFY 2012
83%
National Medicaid Rate
FFY 2013
82%
National Medicaid Rate
FFY 2014
National Averages retrieved via NCQA. (2015). State of Health Care Quality Report.
82%
FL MMA Statewide Average CY 2015
83%

3. Well-Child Visits in First 15 mos. (W15)
Increase the percentage of children who are 15 months of age during the measurement year and have 6 or more Well-Child visits to achieve the Quality Compass 75th percentile.
National Medicaid Average
2012
64%
FL MMA Statewide Average CY 2015
National Medicaid Average
2013
62%
58%
National Averages for Medicaid HMOs retrieved via NCQA. (2015). State of Health Care Quality Report.
National Medicaid Average
2014
59%

4. PPC-Pre and W15 PIP Analysis
11 plans submitted a Prenatal Care and Well Child Care PIP for evaluation.
1 plan submitted a W15 PIP only
ALL plans listed barriers and interventions!!

5. PPC-Pre / W15 PIP Barrier Analysis

6. PPC-Pre and W15 Intervention Analysis

7. PPC-Pre and W15 Interventions
PASSIVE
ACTIVE
Member Rewards Programs
Provider Quality Incentive Programs
Provider Performance Report Cards
Routine Live Outbound Appointment Calls
Utilization of Florida SHOTS Registry
Provider/ Member Newsletters
Brochures
Postcards
Print Materials
Member Invitations/ Announcements
Reminder Letters

8. Opportunities for Improvement
Plans may include interventions focused on addressing health disparities.
Encourage consistent communications between behavioral health and primary care providers, and obstetricians.
Plans may list 3 or 4 “high” priority barriers and link them to corresponding interventions.
Plan may incorporate interventions focused on members who are high-risk for pregnancy complications and who have a mental health condition.

9. Research. Data Collection. Tools. Strategy.
Need Help? Just Ask 
Research. Data Collection. Tools. Strategy.
HSAG will provide Technical Assistance.
The Agency, Bureau of Medicaid Quality serves as a resource to assist the plans with their innovative strategies related to your PIP study topics.
Research resources and helpful tools.

10. Unique Interventions: PPC-Pre & W15
Member-level
Timeliness of Prenatal Care & W15
Healthy Behaviors Perinatal Care Programs
In-Home Visiting/ Outbound Services
Third Party Vendors
Maternal Case Management Programs (e.g., high-risk pregnancies)
Use of Social Media (e.g., campaigns, Text4Baby)

11. Unique Interventions: PPC-Pre & W15
Provider-level
Timeliness of Prenatal Care & W15
Provider Quality Incentive Programs
Provider Engagement/ Advisory Group
Pediatric/ Primary Care Provider Performance Report Card
W15 Compliance Audits of Medical Records

12. Unique Interventions: PPC-Pre & W15
Systems-level
Timeliness of Prenatal Care & W15
Community Clinic Days/Baby Showers
On-Site Provider Coding/ Billing Training
Community & Team-Based Partnerships
Department of Children & Families
Healthy Start Coalition
WIC Program
Third Party Vendors
Large Pediatric Practices

13. Brainstorm New / Modify Interventions
Timeliness of Prenatal Care
Address health disparities/Health literacy
Utilize Text Messaging Applications
Engage fathers or partners
Require providers to screen for smoking, domestic violence, & drug/ substance use
Promote/Improve postpartum & inter-conception care
(e.g., Family Planning Waiver)

14. Brainstorm New / Modify Interventions
Well-Child Visits – 15 mos.
Address health disparities/ Health Literacy
Provider Performance Awards Program
Incentives to parents for scheduling and attending W15 appointment
Parents must bring the child!
Collaborate or Partner with Early Steps/Head Start

15. State Interventions: Nevada
Cribs for Kids Initiative
Implemented to deploy cribs, or other equipment needed by new moms
Moms that completed the required number of prenatal and postpartum care visits within the required time frames
Distribute safe sleep educational survival kits.
CFK: Complete the recommended number of prenatal care visits during your pregnancy (81% of your visits.) may qualify even if they already have a crib. In Spanish and English.
Adopted by North Dakota, New York
Quality Provider Awards: were issued to providers who were recognized as high performers among their peers. The performance measures used as metrics for the program included A1c levels, pediatric immunization compliance, and lowest rate of cesarean section births.

16. State Interventions: California
Baby Blocks Program
Online and mobile engagement tool aligns with the demographic and ethnographic profiles of California’s Medicaid members (e.g., pregnant) enrolled through direct mail, outreach calls, and provider marketing; or text reminders about appointments and tips for healthy living.

17. State Interventions: Washington State
Children’s Preventive Healthcare Initiative
Aim: Increase well child care (WCC) visits and immunization rates for children enrolled in Washington Medicaid’s Healthy Options by 10 percentage points.
Proven Institute for Health Improvement initiative.
Cooperative effort between state policymakers, health plan representatives, and frontline clinic staff.
Develop postcard and telephone outreach to parents of infants and children overdue for a well-child visit.
Develop bilingual reminder postcards.
Develop a system to identify the children overdue for a well-child visit using clinic billing data or managed care health plan data.

18. Resources/References
American Academy of Pediatrics (Health Literacy)
CDC Contraceptive Guidelines for Health Care Providers
Early Childhood Health and Wellness: Health Literacy & Family Engagement:
Medicaid Quality Innovation Center
Mobile Apps
Sense Health:
Text4Baby:
iBirth:
News Article (e.g., connecting hard to reach via technology)
Reproductive Training for Health Centers

19. Questions/Comments?

20. Thank You!!
Janicka D. Harris, MPH Bureau of Medicaid Quality Agency for Health Care Administration (850)