The people behind Community Care — and how we are improving health services in our state
A community-based infrastructure to target patients and populations in need
The processes and measurements behind our outcomes
Access to data to drive our success
New demonstrations, pilots and programs
Management ToolsPatient Management Tools
Patient Management Tools
Materials to support providers and help educate patients
Other CHIPRA Resources
Office of Rural Health and Community Care
NC Center of Excellence for Integrated Care
CCNC Pediatrics (including the CHIPRA Quality Demonstration Grant)
CHIPRA – A Quality Demonstration Grant
The CHIPRA statute mandates the experimentation and evaluation of several promising ideas related to improving the quality of children’s healthcare. CMS awarded 10 grants to states in order to establish and evaluate a national quality system for children’s healthcare, which encompasses care provided through the Medicaid program and the Children’s Health Insurance Program (CHIP). This grant is funded by the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).
North Carolina, via the Division of Medical Assistance (DMA) and the Office of Rural Health and Community Care (ORHCC), was awarded 9.2 million dollars to work on three of the five categories of the CHIPRA Quality Demonstration Grant; A, C and D. The grant projects as outlined in the statute will (A) experiment with and evaluate the use of new and existing measures of quality for children; (B) promote the use of health information technology (HIT) for the delivery of care for children; (C) evaluate provider-based models to improve the delivery of care; (D) demonstrate the impact of model pediatric EHRs; and (E) create targeted models to demonstrate their impact on health, quality, and cost.
CMS is also interested in utilizing the CHIPRA grants, in part, to further CMS’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) goals. These goals include improving access to, utilization of, and reporting of services to which children are entitled under EPSDT in areas such as oral health, vision, hearing, behavioral health, and obesity. Each component of the CHIPRA grant awarded to NC (i.e., performance measurement, provider-based models, and pediatric EHRs) offers opportunities for addressing these goals.
North Carolina will be working with pediatric and family practices within Community Care of North Carolina to build on a strong public-private partnership that has documented successes in quality improvement, efficiency and cost-effectiveness of care for more than 14 years. The following outlines current CHIPRA activities:
Category A – Core Quality Measures (CQM)
- NC reported on 13 of the 24 Core Quality Measures (CQM) at the end of 2011 and hopes to report on 22 of the 24 measures by the end of 2012.
- Selected CQM are being integrating incrementally into CCNC’s Quality Measures and Feedback (QMAF) reporting system. Eight pediatric preventative measures were added in 2011.
- In 2012 an EPSDT Pediatric Profile was developed in conjunction with DMA. The EPSDT Profile provides rates for 12 EPSDT components at a state, network, and practice level each quarter via CCNC’s Informatics Center.
- Pediatric Quality Improvement (QI) coordinators have been incorporated into each of CCNC’s 14 networks. They have been trained by AHEC in QI and receive ongoing data and clinical training related to the CQM by the CHIPRA team each month. The QI coordinators are responsible for providing data, education and coaching to practices on CQM as well as additional pediatric QMAF measures. They are also working to coordinate pediatric teams in each of their networks (if none existed) in order to sustain pediatric initiatives that began with CHIPRA grant.
Category C – Provider Models enhancing care for children with special health care needs
- Eight networks and twenty-six practices (Cohort I-12 practices, Cohort II – 14 practices) are participating in a Learning Collaborative in order to enhance their Medical Home Model for children with special health care needs (CSHCN) with a focus on social-emotional, developmental and behavioral, and mental health.
- Each of the eight networks has 1 full time Quality Improvement Specialist to work intensely with practices. Each of these QIS receives ongoing technical assistance from The Centers of Excellence for Integrated Care and each has received QI training from AHEC.
- Practices have learned to utilize tools such as the AAP Mental Health Toolkit, Motivational Interviewing, Common Factors Approach and valid screening tools for children ages 0-20.
- The Learning Collaboratives have promoted the use of routine screens for children of all ages with special emphasis on: Maternal Depression, Autism, School Age, and Adolescent Screens.
- CHIPRA has encouraged primary care providers and community service providers (specialists, LME, CDSA, schools and public health) ability to build strong relationships, standardize communication and collaborate to promote family centered care.
Category D – Demonstrate the impact of the model Electronic Health Record format for children
- NC and PA are the two States chosen to evaluate the impact of the Children’s Electronic Health Record (CEHR) format.
- NC will assess the utility and functionality of the CEHR requirements for providers that care for children and evaluate improvement in quality indicators
- NC will address the Model’s adequacy to address gaps in current EHR products for pediatric care
- CHIPRA category D will be part of CCNC’s HIE pilot - Discussions are ongoing as the NC HIE evolves.
- The CHIPRA team will be collaborating with NC REC to survey, educate and coordinate information and activities between EHR vendors and practices relating to the implementation of the CEHR format. Ongoing collaboration is occurring at a practice level to limit provider fatigue and streamline resources. REC staff are being identified and orientations are scheduled to introduce the Child Health Care Quality measures and NC’s Model Format evaluation process.
- A national conformance assessment has been completed by AHRQ vendor Westat to determine the current ability of key vendors to meet the Model Format’s requirements.
- To date CHIPRA Category-D has signed Memorandums of Understanding with three vendors (Office Practicum, ReLi Med Solutions, and Patagonia Health) and has begun orientation with them on NC’s approach to the Model Format evaluation.
- Provider orientations have been scheduled and three participating practices have begun submitting their evaluations of the first set of requirements from the Model Format.
- Participating vendors have submitted estimates for interfacing with CCNC for automating delivery of clinical quality measure reports for the project.
- Several participating vendors have either implemented or are exploring “packaged solutions” such as CHADIS, a web-based screening, diagnostic and management system that can interface with an EHR. Click here to view a CHADIS demonstration conducted on January 24, 2013 for the Pediatric Workgroup.