Public health, Medicaid QI initiatives find common ground
States are trying to do a better job of aligning their public health goals with quality improvement initiatives in Medicaid, with the goal of increasing efficiencies in state spending.
"Medicaid managed care plans are an important component of state public health efforts," says Deborah Kilstein, director of quality management and operational support for the Association for Community Affiliated Plans (ACAP) in Washington, DC. "I expect the drive to meet public health goals will continue."
Medicaid managed care provides access to a guaranteed network of providers, with an emphasis on primary and preventive care services and continuous quality improvement.
"Moreover, ACAP health plans have a long-standing tradition of working closely with community-based providers, including community health centers," says Ms. Kilstein.
Medicaid health plans, says Ms. Kilstein, have worked steadily to raise the Healthcare Effectiveness Data and Information Set (HEDIS) scores submitted to the National Committee for Quality Assurance for a number of measures related to leading indicators for Healthy People 2010.
For example, the HEDIS scores for the number of children enrolled in Medicaid health plans who received all necessary immunizations increased by more than 50% since 2005, and adolescent immunization HEDIS rates more than doubled between 2002 and 2006.
"Health plans are committed to ongoing quality improvement efforts and will work to further these gains over time," says Ms. Kilstein.
While there may have been some tension between health departments and Medicaid health plans in the early days of Medicaid managed care concerning roles and responsibilities, Ms. Kilstein says these issues have been resolved.
"A case in point is lead screening," she says. "Medicaid health plans have forged partnerships to work collaboratively with state and local public health departments, to ensure that every child is screened in accordance with federal guidelines and provided appropriate treatment and case management."
In Kansas City, MO, Children's Mercy Family Health Partners (CMFHP), a not-for-profit safety net health plan owned by Children's Mercy Hospitals and Clinics, identifies children who require lead screening and does extensive outreach and member education, both by mail and telephone. In addition, ongoing education is provided to primary care providers and community agencies.
Through a focused initiative, CMFHP increased lead screening rates by 34% to 44% in enrolled children aged 6 to 36 months.
CMFHP operates an integrated care system that contracts with the states of Kansas and Missouri to provide health insurance benefits to children and adults who are eligible for Medicaid or the State Children's Health Insurance Plan. Most local health departments contract with the health plan for reimbursement for the lead screenings, and CMFHP often participates in lead screening events as an educational and community resource. To ensure follow-up, laboratory results are shared between the health plan and the state department of health.
CMFHP then provides ongoing care management to any child identified with elevated lead levels, while environmental assessment and remediation efforts are coordinated with the state health department. Health plan reporting serves to close the loop for monitoring and oversight purposes.
"We believe the program we have developed in collaboration with the state of Missouri is an example of how the managed care plans and public health can collaborate to achieve better outcomes," says Ma'ata Touslee, CMFHP's chief clinical officer.
The managed care plan's role is to coordinate care for children with lead levels 10 or higher to ensure appropriate identification and remediation is in place. "In addition, we are responsible to actively educate our members on the importance of lead screening in children and promote education with our contracted providers," says Ms. Touslee.
To achieve these goals, CMFHP has dedicated Lead Toxicity Care Managers who work collaboratively with the state, public health departments, providers, and members. Here are some of the functions within the program:
For identification and referrals to care management:
A monthly report is created on all the identified children within the health plan who have had a lead screening and the results.
Lead care management activities are entered in the state's Missouri Health Strategic Architectures and Information Cooperative database for all public health agencies to view.
The state is notified about any members not on the state's report who CMFHP has learned have had lead screening and the results of the screening.
A lead screening is utilized as part of the high-risk obstetrics care management program.
Members are asked about lead screening compliance when they join CMFHP, as part of the new member Health Risk Assessment process.
Additional members who need lead screening are identified by working with Mid-America Head Start.
For provider education:
A provider Quick Reference Guide was developed on lead screening and billing.
Periodic lead toxicity articles are submitted to the quarterly provider newsletter.
A one-hour CE/CEU program on lead toxicity is offered to CMFHP provider offices.
State Advisory meetings are attended.
A lead audio series is available on the CMFHP web site (www.fhp.org).
For member education:
Lead educational packets are mailed to members identified with high lead levels or with no history of recommended lead screenings.
Home visits and assessments are completed for members who are not currently being followed by one of the state public health departments for lead monitoring.
Member education is coordinated with local public health departments to ensure members are receiving recommended home visits and environmental assessments, if needed.
Guest speakers are provided to discuss lead screenings on local radio stations.
Periodic lead toxicity articles are submitted.
Ms. Touslee says she would like to see the program serve as a model for other states. "We have already used it as a model to implement our lead care management initiative in the state of Kansas, where the state's program is less structured," she says.
Ms. Kilstein at (202) 341-4101 or [email protected].
States are trying to do a better job of aligning their public health goals with quality improvement initiatives in Medicaid, with the goal of increasing efficiencies in state spending.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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