Adolescent Health Care

Maureen Mullen, Hartford Action Plan, continued the discussion of adolescent health care access in HUSKY, identifying broad issues of quantifying access to services, comprehensiveness of adolescent well care visits, coordination of health services across disciplines for adolescents, confidentiality issues, and adequacy of funding for services and capacity of the provider system to meet the health care demand if adolescent access were improved. One can view adolescent health care from a system perspective, that includes care fragmentation, funding resources, administrative capacity of providers, as well as from a health care perspective of access to preventive and episodic care. School-based health clinics (SBHC) are key providers of adolescent care, yet they struggle with administrative burdens associated with managed care that result in under-reporting of services as well as care collaboration with a youth's designated primary provider.

Various initiatives have been undertaken that address aspects of adolescent health care that include:

· Children's Health Council data tracking on youth health care access and recently convened EPSDT revitalization group of MCO's and DSS that will include a focus on teen health care in HUSKY.

· Hartford Action Plan works with MCO's and providers to promote age-appropriate comprehensive care with a focus on teen-focused reproductive care and confidentiality issues.

The subcommittee chair will discuss adolescent health care issues in HUSKY with Senator Harp and the co-chairs in order to define a subcommittee focus in HUSKY. This will be discussed and decided at the October meeting.

Children's Health Council EPSDT Revitalization Initiative

Kathy Willis described this work group that was formed in response to the evident flattening of EPSDT utilization. The group looked at policy, program administrative, and client and provider behaviors that may contribute to low access with teens (see attached description).

Debby Brackett (Qualidigm) noted that the Council and subcommittees might want to consider recommendations for future Qualidigm projects for the new January 2002 contract. Ms Brackett will be starting a new endeavor; this is her last meeting with the Council and subcommittees. Paula Armbruster expressed appreciation for Ms. Brackett's work with the subcommittee and the projects that measure the quality of the HUSKY program.

Asthma Work Group

MCO/Provider Work Group Report

The 9/12 meeting discussion was summarized (see summary attached) and this Work Group agreed upon and added to, the QA subcommittee recommendation to the Medicaid Council (in October) suggested by the work group:

The HUSKY A Managed care plans:

· Identify the following asthma items carried by each of their local vendors in New Haven and Waterbury:

o Spacers

o Nebulizer

o Nebulizer accessories

o Dust mite covers

· Survey the local vendors regarding:

o Acceptance of faxed prescriptions from health providers

o Delivery of items to patient's residence, delivery time availability

· The Health plans report this information back to the QA subcommittee Asthma Work Group at the November.

· The QA Subcommittee will report back to the Medicaid Managed Care Council in December.

Anthem BlueCare Family Plan (ABCFP) Asthma Disease Management Program(DMP)

Gloria Criscuolo described ABCFP asthma management program:

· Previous Asthma DMP included:

o Identification of members with asthma through the claims data and provision of asthma education materials to these members.

o Case management of members with 2 Emergency Dept visits or 1 hospitalization for asthma that includes a member voluntary home visit that assess asthma triggers, medication compliance and the member's understanding of this. Information from this home visit is communicated to the Primary Care provider.

· Current DMP includes the following changes

o Using claims data for risk stratification based on hospital and ED admissions, pharmacy data.

o Using pharmacy data of filled prescriptionsto assess appropriate use of medication. Communicate information of non-filled or inappropriate use of asthma meds to the PCP.

o Client case management: added focus on patient stabilization, with 2 phone calls to identified high-utilizer members (non-clinician scripted call). Members with asthma management problems identified by the member's response to the scripted questions will be placed back in intensive case management for a 12-month follow up by the plan. This information is communicated to the member's PCP.

The subcommittee Asthma Work Group will provide the other health plans with an opportunity to discuss ongoing or planned DMP at the next meeting.

CHC Asthma Report

Mary Alice Lee reported on the 3^rd annual report from the CHC on asthma prevalence and utilization among children <21 years continuously enrolled in HUSKY A for 11/12 months. (see report brief www. childrenshealthcouncil.org). The review of HUSKY A claims data showed that estimated asthma prevalence for this group was 8. 8% in 1999-2000 compared to 9. 8% in 1998-99. In 1999-2000 one in four children with asthma was seen in the ED and 5% were hospitalized. Hospitalization rates were unchanged; however asthma children with >1 hospitalization decreased from 22% in 1998-99 to 12% during this report period. Overall ED visit rates were unchanged; however rates for > 1 ED visit declined slightly.

The study conclusions include:

· Approximately 1 in 10 children in the study group was affected by asthma.

· Asthma prevalence is highest among young children, Hispanic children and children living in Bridgeport and Hartford.

· Ambulatory care utilization was unchanged from previous years; however ED (25%)and hospitalization (5%) rates remain high.

The QA subcommittee will meet Thursday October 18. 10: 30 AM, preceded by the asthma work group at 9: 30 AM. The MCO/provider group will meet Tuesday October 23, 5: 30 PM at CHA.