Connecticut
Medicaid Managed Care Council

Quality Assurance Subcommittee

Legislative Office Building Room 3000, Hartford CT 06106
(860) 240-0321 Info Line (860) 240-8329 FAX (860) 240-0023
www.cga.ct.gov/ph/medicaid

Meeting Summary: January 20, 2005

Chair: Paula Armbruster

(Next meeting: Tuesday, February 15,2005 @ 1:30 PM in LOB RM 2600)

2004 In Review, Updates, 2005 Follow-up

Topic area	2004 SC Activities	Updates	2005 Proposed SC FU Activities
Pediatric Obesity	SC recommendations approved by MMCC 9/04. Matrix on HUSKY obesity-related covered services done, sent to MCOs, on MMCC web site..	Dec 2004 SC, how to assess prevalence in HUSKY, promote clinical evaluation guidelines Select Committee on children: 2/8, 11:30 hearing on juvenile obesity concept LOB 2AFU public hearing 12 PM	*Continue work per 12/04 discussion
Adolescent Health	SC report & recommendations led to DSS MCO contract QIP SC working with DSS, MCOs, PCPs in revising state Med EPSDT form, anticipatory guidance items	Ongoing EPSDT work group in form & Anticipatory Guidance revision. DSS.MCO develop a common PIP for Teen access to health care & quality measures of care.	Continue focus through work group, MCO ongoing QIP, format of new PIP.
Lead Poisoning/Prevention	Presentations by DPH on computer system progress, LAMPP program Sen. Harp request for recent DPH/DSS lead match on Hartford data for MCO FU, work with community programs	Dr. Donna Balaski (DSS) to direct lead MOU activities with DSS & DPH: -Lead match thru 9/03 to be given to MCOs for FU of 1) children who have not had screens 2) FU of those with lead levels >10ug/dl 3) FU with levels >20ug/dl - Lead match for Hartford for 10/1/03 forward., DSS/MCO/CBO/local HD on these reports.	Follow up 10/1/02-9/30/03 match, MCO response and status of recent data match for Hartford as an initial focus with MCOs, DSS, CBO, local health department.
HUSKY adult/child health	Request DSS look at ER visits by age, gender, top diagnoses. Requested DSS report on hospital admissions	DSS will ask Mercer to do this and DSS/MCOs will focus on asthma-related ED visits, MCO assessment and action plans to reduce ED asthma-related visits. *Will need to discuss with Rose Ciarcia (DSS)	SC to Follow up on ED visits Staff will follow up with DSS.
Quality of Asthma care for adults/children	Requested DSS have MCOs report on % children and adults in HUSKY A with persistent asthma who received appropriate medications to control asthma.	DSS will request MCOs to report this.

Subcommittee Discussion for 2005 Focus

Ø Data systems & applicability to quality measurements. Dr. Kamens stated that what is needed is a more universal data system rather than individual quality projects, timely data and performance feedback to practitioners, identification of problem areas, engagement of allies in executing a quality action plan.

o The CIRTS registry is an example of success in gathering and using data for improvement in childhood immunizations. It was noted that CT has one of the highest immunization rates in the country.

o Software is available to query a database and receive prompt responses that would inform quality performance and shape quality initiatives in HUSKY and other CT health providers.

o The DSS is developing a data warehouse that will give the agency access to their programs’ data and evaluation of health care. The DSS will begin discussing this at the Jan. 21 Medicaid Council meeting.

Ø Systematic identification of and response to pregnant women’s needs/risks, through a uniform PNC MCO registration form and collaboration with community providers and MCO in engaging, keeping women in PNC. The MCOs collect similar information and define ‘at-risk’ pregnant women based on AGOG standards. Practitioners have asked if the MCOs could agree to use the same form across the 4 plans in gathering demographic and clinical information from providers on the woman’s health status and risk. The three plans (Anthem was unable to attend) present thought that would possible; they will discuss this among themselves and report back in March.

Ø Persistent issue of HUSKY members that do not access health services, estimated to be about 10-15 percent. The Chair would like the subcommittee to look at this further. (Jan. 21 MMCC meeting, CTVoices reported on 2003 ambulatory care for HUSKY A children. For 12-month continuously enrolled children, aged 2-19 years, 85% received ambulatory services (office visits, clinic visits, emergency visits), 10% had no record of care and 5% had other services but no documented ambulatory care. Thirty-four percent of those with ambulatory care had acute or emergency care only and only 51% had well care. See report at www.ctkidslink.org).

Ø There was agreement to follow-up on the 2004 activities.

Updates

DSS

Hilary Silver introduced Dr. Donna Balaski who is working on DSS HUSKY dental as well as lead management. Ms. Silver described two optional studies that Mercer will be doing:

· Health care for DCF children in HUSKY

· Pediatric obesity: Mercer will examine the encounter data for obesity proxy ICD9/CPT codes such as diabetes, nutritional services, obesity-related co-morbidities, ED visits related to these.

HUSKY Obesity Surveillance

Dr. Geertsma reported on the feasibility of using a blank field on billing forms for recording the BMI. It is not efficient to do this only for BMI. On approach could be for the MCOs to give practitioners the calculators for child/adult BMI. There is a need for follow up on screens for overweight and co-morbidities associated with excessive weight.

Next meeting is scheduled for Tuesday Feb 15 at 1:30 PM in LOB RM 2600; however a different day and time needs to be identified by the group at the next meeting.