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“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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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?
ME CHIP Meeting 2/13/15 5
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
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Input on Planning Potential Future Work on Adolescent Medicine
ME CHIP Meeting 2/13/15 7
• 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
ME CHIP Meeting 2/13/15 8
Baseline Data
ME CHIP Meeting 2/13/15 9
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
ME CHIP Meeting 2/13/15 10
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%)
ME CHIP Meeting 2/13/15 11
• 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
ME CHIP Meeting 2/13/15 12
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?
ME CHIP Meeting 2/13/15 13
• 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
ME CHIP Meeting 2/13/15 14
Ideas for Topics
ME CHIP Meeting 2/13/15 15
•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
ME CHIP Meeting 2/13/15 16
Potential Partners
ME CHIP Meeting 2/13/15 17
• 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 Meeting 2/13/15 18
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 Meeting 2/13/15 19
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.
ME CHIP Meeting 2/13/15 20
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
ME CHIP Meeting 2/13/15 21
• 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”
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Next Steps
ME CHIP Meeting 2/13/15 23
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
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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
25ME CHIP Meeting 2/13/15