Quality in Medicaid and CHIP: From Vision to RealityFacilitated by Marsha Lillie-BlantonDirector, Division of Quality, Evaluation & Health OutcomesChief Quality Officer, Center for Medicaid and CHIP Services

The CMS Healthcare Quality ConferenceBaltimore, MD | December 2 – 4, 2014

Follow us on Twitter:@QIOProgram

Tweet with our conference hashtag:#QualityNet14

CMS QualityNet Conference Kickoff and Technical Assistance Team IntroductionsMarsha Lillie-BlantonDirector, Division of Quality, Evaluation & Health OutcomesChief Quality Officer, Center for Medicaid and CHIP Services

Agenda

• Grantee Welcome – Eliot Fishman• The CMCS Maternal and Infant Health

Initiative – JudyAnn Bigby• The CMS Oral Health Initiative – Patrick Finnerty

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Center for Medicaid and CHIP Services (CMCS) Grantee WelcomeEliot FishmanDirector, Children & Adults Health Programs GroupCenter for Medicaid and CHIP Services

The CMCS Maternal and Infant Health InitiativeJudyAnn BigbyClinical Advisor, Center for Medicaid and CHIP Services QI 301 SeriesSenior Fellow, Mathematica Policy Research

Agenda

• Overview of the Maternal and Infant Health Initiative• Importance of this initiative to improve women’s health• What are some of the opportunities?• What are some of the challenges and how can we

overcome them?

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Improving the Health of Mothers and Infants in Medicaid and CHIP: Initiative Goals

Building on the 2012 Expert Panel on Improving Maternal and Infant Health Outcomes in Medicaid and CHIP, in July 2014 CMCS launched a multi-pronged strategy to achieve two goals over a 3-year period in 20 states:

1. Increase by 10 percentage points the rate of postpartum visits among women in Medicaid and CHIP

2. Increase by 15 percentage points the use of effective contraception among women enrolled in Medicaid and CHIP

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Initiative Strategies and Activities

Strategies• Engage states, providers,

and beneficiaries• Leverage federal

partnerships• Strengthen technical

assistance• Measure quality and

improve performance

Activities• Improving Postpartum

Care Action Learning Series

• Development of quality measure for contraceptive utilization

• Funding opportunity• Quarterly webinars

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Opportunity to Improve the Postpartum Care Visit Rate

Medicaid and Commercial Health Plan Postpartum Care Visit Rates HEDIS 2013

Source: NCQA HEDIS Database

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Improving Postpartum Care Action Learning Series

• Eleven states are engaged in quality improvement projects

• States are exploring a range of strategies– Adapting Medicaid payment policies– Leveraging contractual agreements with managed care

organizations– Building supports to engage women in their own care– Partnering with community social service agencies – Partnering with health homes

• States also want to address disparities, improve access to contraception, and link their efforts to other initiatives, such asText4baby and the Collaborative Improvement & Innovation Network (CoIIN)

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Closing Comments

• Opportunities to build on state experiences• Overcoming challenges

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Contact

JudyAnn BigbyClinical Advisor, CMCS QI 301 SeriesSenior Policy Fellow, Mathematica Policy Researchjbigby@mathematica-mpr.com

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The CMS Oral Health InitiativePatrick W. FinnertyPresident, Board of Directors, Virginia Dental Association FoundationFormer Virginia Medicaid Director

Medicaid and Children’s Oral Health

Any Dental Serviceages 1-20

2001 28.8%

2007 37.1%

2008 39.0%

2010 46.4%

2011 47.3%

2012 48.0%

Events2001 CMS announces reviews of states

with dental utilization < 30%2007 Congressional hearings2008 CMS announces reviews of states

with dental utilization < 30%2010 CMS announces oral health

initiative2011 CMS reviews 8 innovative states2013 CMS sets oral health initiative

baselines and goals

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CMS Oral Health Initiative – Goals

Goal #1 – Increase by 10 percentage points the proportion of Medicaid and CHIP-enrolled children ages 1 to 20 (enrolled for at least 90 days) who receive a preventive dental service

• Baseline year is FFY 2011• National baseline is 42%• National progress by FFY 2013 is 44%• Goal year is FFY 2015. National goal is 52%• Every state has its own baseline and goal

Goal #2 – Increase by 10 percentage points the proportion of Medicaid and CHIP-enrolled children ages 6 to 9 (enrolled for at least 90 days) who receive a sealant on a permanent molar tooth

• CMS is working on operationalizing this goal

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Top 10 States with a 10 Percentage Point or Greater Increase in Preventive Dental Services

Percentage of Medicaid-enrolled children, ages 1-20, who received a preventive dental service, FFY 2007 – FFY 2011

Source: FY 2000-2011 CMS-416 reports, Line 1, Line 1b, 12bNote: FY 2011 data for Idaho, Kentucky and Ohio are not yet available. Estimates for these states are included in the National figure for FY 2011, but they are excluded from consideration as "Top 10" states for this analysis** In 2010, CMS changed the population measure d from all enrolled children to children enrolled for at least 90 continuous days.16

Steady Progress in Access to Dental Care

FFY 2000 – FFY 2012

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012*

Any Dental

Preventive

Treatment

Source: FFY 2000-2012 CMS-416 reports, Lines 1, 1b, 12a, 12b, and 12c.Note: *FFY 2012 data for Connecticut is not yet available and was substituted with FFY 2011 data. Data reflects updates as of 4/03/14.

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FFY 2011–FFY 2013: Two-Year Progress on Preventive Services Goal

Percentage point difference in use of preventive dental services by children, ages 1-20, enrolled in Medicaid for at least 90 days who received a preventive dental service (12b)

-4%

-2%

0%

2%

4%

6%

8%

10%

12%

Mon

tana

Indi

ana

Iow

aM

aine

Idah

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evad

aN

ebra

ska

Kans

asN

ew M

exic

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est V

irgin

iaPe

nnsy

lvan

iaU

tah

Mic

higa

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ew J

erse

yN

orth

Car

olin

aIll

inoi

sM

aryl

and

Mis

siss

ippi

Mis

sour

iM

assa

chus

etts

Haw

aii

Con

nect

icut

Okl

ahom

aA

rkan

sas

Del

awar

eTe

nnes

see

Was

hing

ton

New

Yor

kG

eorg

iaN

atio

nal*

Loui

sian

aAl

abam

aW

yom

ing

Virg

inia

Verm

ont

Ore

gon

Wis

cons

inN

orth

Dak

ota

New

Ham

pshi

reD

istri

ct o

f Col

umbi

aM

inne

sota

Cal

iforn

iaC

olor

ado A

rizon

aAl

aska

Five-yearGoal

Two-yearGoal

Kent

ucky

Rho

de Is

land

Sout

h C

arol

ina

Sout

h D

akot

aTe

xas

Source: FFY 2011-2013 CMS-416 reports, Line 1b, 12bNote: *FFY 2011 data for Ohio and Florida are not available. Data for Florida has been substituted with FFY 2012 data. Data for Ohio has been excluded. Estimates for Florida are included in the National figure. Data has been rounded.18

FFY 2013: Percentage of Children in Medicaid Who Received Dental Sealant

Percentage of Children, Ages 6-9, Enrolled in Medicaid for at Least 90 Days Who Received a Sealant on a Permanent Molar, FFY 2013

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Mas

sach

uset

tsIll

inoi

sN

ebra

ska

Conn

ectic

utN

ew H

amps

hire

Mai

neW

ashi

ngto

nAl

aska

Kans

asIn

dian

aN

orth

Car

olin

aTe

xas

Dela

war

eM

aryl

and

Colo

rado

Idah

oM

onta

naN

evad

aTe

nnes

see

New

Mex

ico

Uta

hDi

stric

t of C

olum

bia

Iow

aCa

lifor

nia

Verm

ont

Virg

inia

Nat

iona

lSo

uth

Caro

lina

Wyo

min

gM

ississ

ippi

Wes

t Virg

inia

Penn

sylv

ania

New

Jers

eyAr

izona

Min

neso

taLo

uisia

naO

rego

nAr

kans

asSo

uth

Dako

taAl

abam

aM

issou

riGe

orgi

aKe

ntuc

kyN

ew Y

ork

Wisc

onsin

Mic

higa

nN

orth

Dak

ota

Haw

aii

Rhod

e Is

land

Okl

ahom

aFl

orid

aO

hio

Source: FFY 2013 CMS-416 reports, Line 1b, 12dNote: Data reflects updates as of 10/22/14.

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Medicaid Oral Health Learning Collaboratives

Center for Health Care Strategies (funded by DentaQuestFoundation)

CMS Learning Collaborative

AK

HI

CA

AZ

NV

OR

MT

MN

NE

SD

ND

ID

WY

OK

KSCOUT

TX

NMSC

FL

GAALMS

LA

AR

MO

IA

VA

NCTN

IN

KY

IL

MIWI

PA

NY

WV

VT

ME

RICT

DEMD

NJ

MANH

WA

OH

D.C.

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CMS Learning Labs

• Quarterly technical assistance webinars, targeted primarily to state Medicaid programs but open to all

– Successful Beneficiary Outreach Strategies

– Quality Improvement Processes: An Introduction for Medicaid and CHIP Dental Programs

– Engaging More General Dentists to Care for Young Children: Access to Baby and Child Dentistry (ABCD) in Washington and South Dakota

– Dental Sealants: An Effective State Strategy to Prevent Dental Caries in Children

• State Medicaid and CHIP Program Support of Sustainable Oral Health Care Delivery Models in Schools and Community-Based Settings

• Building a Partnership Between Medicaid and Head Start: the Pennsylvania Model

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Successful Approaches in Other States

• Washington State: Access to Baby and Child Dentistry

• North Carolina: Into the Mouths of Babes

• Texas and Virginia: Preventistry

• New Hampshire: Partnership with WIC

• Iowa: I-Smiles

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/Keep-Kids-Smiling.pdf

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Insure Kids Now Dental Provider Locator

Download the Widget: http://datawarehouse.hrsa.gov/tools/widgets.aspxUse the Dental Provider Locator Tool: Go here http://www.insurekidsnow.gov/state/index.html then click on your state23

Think Teeth!

• Three free materials:• For babies and

toddlers up to age 3• For children of all

ages• For pregnant women

• English/Spanish• Can be bulk-ordered

for free from CMS

http://www.insurekidsnow.gov/professionals/dental/index.html24

Contact

Patrick W. Finnertypwfinnerty@aol.com804-929-3318

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