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) 240-8307
www.cga.state.ct.us/ph/medicaid
Chair: Maureen Mullen
Connecticut was one of three states (along with West Virginia & California) chosen to participate in a National Association of School Based Health Clinic (NASBHC) Preventive Services Improvement Initiative Care Model. Two SBHCs in Danbury, Bridgeport and Stamford participated in the initiative. The goal of the initiative was the ensure annual preventive health risk assessments were done for each SBHC client, using a modified GAPS assessment tool, accompanied by documentation of referrals for areas of need identified in the health risk assessment. As part of the initiative, behavioral health was integrated with physical health, with the nurse practitioner asking questions in the GAPS tool about both areas of the young person’s life and working with the SBHC social worker on meeting identified behavioral health risk areas. Since SBHC are not designated primary care providers (PCP), the clinics worked on developing an information system with the student’s PCP, obtaining permission to release information to the PCP.
Subsequent to the NASBHC initiative, the DPH is working with other SBHCs throughout the state to standardize the use of EPSDT codes in order to bill managed care organizations for services provided. Building on the SBHC MIS system and the Clinical Fusion program, this year’s project will focus on entering data from the health risk form and identify those with key chronic diagnoses (i.e. asthma, diabetes).
Each community site identified 3 goals as part of the Initiative:
The Work Group discussed building a common risk assessment approach, prioritizing key areas that would be included in any tool used for a preventive health visit that would be accompanied by anticipatory guidance guidelines. While there was recognition that at least depression and suicide risk is important to screen in a preventive visit, there was concern expressed that 1) many medical providers may not be comfortable in asking these questions, 2) have a lack of information about community referral resources and 3) lack of availability to some of these resources. Suggestions were made to make available resources such as the United Way Infoline to medical providers as well as look to local health departments in identifying geographic-based adolescent MH resources for medical providers. (Previous Work Group suggestions included CME programs for providers on adolescent preventive health that could include the MH screens) Anthem has been working with CCMC on a pilot that supports the PCP in assessing MH issues and identifying available resources.
Dorothy Pacyna (DPH) reviewed the information from the six 2001 Teen focus groups, performed by the CT Human Services Association for DPH that assessed adolescent concerns about health care access, compared their experiences with SBHC and other community providers and listed adolescents’ recommendations about delivery of services to this age group.
Youth described preferences for a health provider that identified provider characteristics and behaviors that lead to a rapport with the youth, the importance of continuity of care with the same provider, concerns about the perceived lack of confidentiality as the major barrier to care from community-based providers and the positive aspects of care received from SBHC. The latter reinforced the positive provider characteristics that result in the youth feeling more rapport with their health provider and comfort in disclosing health concerns. Recommendations came from the youth focus groups that included the:
The results of this report mirror the comments and recommendations of the adolescents that have taken the time to participate in this work group. Consideration of adolescent feedback regarding their health care is key to developing a health care delivery system that is more relevant to their health concerns. Access to preventive services may improve with the implementation of the recommendations.
The managed care organization work group will meet on January 10, 2003 to consider the process of using validated tools in surveying teens on their health care experiences within the HUSKY program. This information would be used to develop practitioner education programs related to adolescent care.
DSS/MCO: How to Accomplish:
The work group identified the need to revise anticipatory guidance guidelines to include those areas pertinent to adolescent preventive care. It was suggested that a small subgroup meet to 1) review guidelines from other organizations such as the Academy of Pediatricians and the Family Practice 2) add age-appropriate guidelines on the State form and 3) consider how practitioners can use this form.
Adolescents tend to have greater utilization of episodic visits for acute health problems rather than preventive health care visits. At previous work group meetings it was noted that a modified EPSDT code could be used IF EPSDT components were part of the acute care visit. The subgroup that revises the EPSDT State form may identify how and if practitioners can bill the MCOs with the modified codes.
Maureen Mullen described the conference on Dec. 10, sponsored by the Hartford Action Plan, which will address Hartford Teen pregnancy. Jonathan Kline, who has developed an abbreviated teen health risk form in New York State in collaboration with Empire Blue Care and the NYS Health Department, will present information of this initiative.
The Medicaid Council Behavioral Health Subcommittee heard a brief overview of Dr. Steven Cole’s (UCONN Health Center) work on an adolescent depression initiative. Dr. Cole agreed to provide this information to this work group.
A preliminary draft of the work group’s report was shared; further work will be done on this to include additional issues raised in the work group. The goal is to have the work group’s final approval of the report by the January 7 meeting, presentation to the Quality Assurance Subcommittee in January and the Medicaid Council in February.
The Adolescent EPSDT Work Group will meet Tuesday January 7 at 4:30 PM in LOB RM 2600. If bad weather necessitates cancellation of the meeting, an email alert will be sent out as well as notice of the cancellation on the Council’s direct line voice message: (860) 240-0321.
Senator Harp thanks all of you for your diligence and
hard work in addressing this important health care issue and appreciates
Maureen Mullen’s leadership with in the work group. We wish you all a safe and Happy Holiday.