1. MARCHING TO THE BEAT OF A DIFFERENT DRUM

2. Two States Experience Using the CHIPRA Quality Grant and ABCD To Test and Evaluate Promising Ideas To Improve the Quality of Children’s Health Care NASHP’s 23rd Annual State Health Policy Conference October 5, 2010 Charles A. Gallia, PhD, Manager Research and Analysis Oregon Department of Human Services Felicity Costin Myers, Ph.D., Deputy Director of Medical Services South Carolina Department of Health and Human

3. Background To better understand the session, we need to look at two programs that were leaders pre-health reform These programs were designed to empower states to develop new models of coordination and linkages for children’s health (Medicaid and CHIP) post EPSDT  Assuring Better Child Health and Development (ABCD)  The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

4. ABCD The Assuring Better Child Health and Development (ABCD) Program is funded by the Commonwealth Fund, administered by NASHP, and was designed to assist states in improving the delivery of early child development services for low-income children and their families by strengthening primary health care services and systems that support the healthy development of young children, ages 0-3 The first ABCD Consortium (ABCD I) was created in 2000 and provided 3 year grants to four states to develop or expand service delivery and financing strategies aimed at enhancing healthy child development The ABCD II Initiative was a 4 year initiative launched in 2003 designed to assist 5 states in building the capacity of Medicaid programs to deliver care that supports children’s healthy mental development

5. ABCD The ABCD Screening Academy began in April 2007 and provided technical assistance to 21 states/territories to increase use of an AAP general developmental screening tool as a part of health supervision during well-child care provided by primary care providers who act as young children’s medical homes ABCD lll, which began in October 2009, will work with 5 states to develop and test sustainable models for improving care coordination and linkages between pediatric primary care providers and other providers who support children's healthy development

6. CHIPRA The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) was created to improve access to and the quality of care provided to children. In particular, Title IV of CHIPRA creates a broad quality mandate for children's health care and authorizes child health care quality initiatives for both the CHIP and Medicaid programs. CHIPRA provided award of grants to evaluate promising ideas for improving the quality of children's health care

7. CHIPRA On February 22, 2010, the Centers for Medicare & Medicaid Services awarded a total of $20 million in first-year CHIPRA Quality Demonstration Grant funds to 10 states: Colorado (New Mexico), Florida (Illinois), Maine (Vermont), Maryland (Georgia and Wyoming), Massachusetts, North Carolina, Oregon (Alaska and West Virginia), Pennsylvania, South Carolina, and Utah (Idaho) Eight of the 10 grantees will test a recommended set of child health quality measures, seven of the ten states will use the funds to implement health information technology (HIT) strategies, and two states specifically plan to test a new pediatric electronic health record format being developed under CHIPRA

8. CHIPRA Awardee Projects Colorado and New Mexico will form an Interstate Alliance of School-Based Health Centers (SBHCs) to integrate school-based health care into a medical home approach to improve the health care of underserved school-aged children and adolescents. Florida, in partnership with the State of Illinois will test collection and reporting of recommended and selected supplemental measures of children’s health quality, using existing data sources and improved data sharing. Florida and Illinois will also work to support collaborative quality improvement projects to improve birth outcomes across the two States. State of Maryland, in partnership with Georgia and Wyoming will implement and/or expand a Care Management Entity (CME) provider model to improve the quality and better control the cost of care for children with serious behavioral health challenges who are enrolled in Medicaid or the Children’s Health Insurance Program. Pennsylvania will partner with several medical centers and hospitals to test and report on recommended pediatric quality measures and promote the use of health information technology in health care delivery to maximize the early identification of children with developmental delay, behavioral health issues, and those with complex medical conditions.

9. Conversation with Two States Today we are going to have a conversation with two states that are looking at these initiatives in two unique ways  Oregon an ABCD state and also a CHIPRA awardee - they developed a partnership with Alaska and West Virginia to develop and validate quality measures, improve infrastructure for electronic or personal health records utilizing health information exchanges, and implement and evaluate medical home and care coordination models  South Carolina a CHIPRA awardee - they plan to build a quality improvement infrastructure that enhances the ability of 15 of the State’s pediatric primary care practices to establish medical homes that effectively coordinate and integrate physical and mental health services and where health information technology will be used to gather, aggregate, and report on outcomes