Meeting Summary: October 20, 2005

Chair: Paula Armbruster

(Next meeting: Thursday December 1, 2005 @ 9 AM in LOB RM 3800)

DSS Update

Lead data match – DPH/DSS

Dr. Donna Balaski (DSS) provided an update on DSS’s work with MCOs on member lead data:

• DSS distributed lead data for members < 6 years that have not been tested. The MCOs are working collaboratively to:

o Create a uniform letter to providers on the importance lead screening

o Work with the Lead Action for Medicaid Primary Prevention (LAMPP) program through a DSS/MCO/LAMPP work group to prevent lead poisoning by increasing practitioner screening and LAMPP lead containment/abatement through referral of families with children with who have elevated lead levels.

• DSS is working with DECD to fund LAMPP with an additional $0.5 million dollars to assist with a lead abatement project in Hartford.

• The DPH Public Health Foundation of CT, Inc has launched its first privately funded health initiative targeting childhood lead poisoning and prevention through a $200,000 grant from ConnectiCare.

• On November 17 from 8 AM –12 noon in LOB RM 2A there will be a roundtable discussion, sponsored by Senator Toni Harp, Rep. Peggy Sayers and the Health Education Lead Poisoning (HELP) Coalition on policy direction and action plan to end childhood lead poisoning in CT by 2010.

Emergency Room Utilization

Over the past 3 years ED use in the HUSKY A program has increased to 56-59/1000 member months (59/1000MM is approximately 720 ED visits/1000 members). Under Medicaid Fee For Service (FFS) ED use was 72/1000MM. The MCOs recognize this troubling trend and each MCO has made previous efforts toward contacting members with frequent ED use, contacting members that haven’t used any services within a specified time from health plan enrollment and contacting providers whose patients may have high ED use. In addition, all MCOs are involved in the Performance Improvement Program (PIP) to analyze and address asthma-related ED visits for children and adults in HUSKY.

Beginning January 2006, each MCO will have developed a more systematic program to address their increasing ED use rates. At the January Quality Subcommittee meeting the plans will provide adult/child demographics of members who use the ED and for those that have high ED use and outline their plans to address high ED use.

Addendum: Kaiser Statehealthfacts.org (compares overall CT ED use with the US, in each year CT has a higher ED use compared to the rest of the country.

Women’s Forum Plans

Amy Gagliardi outlined the content for a January or February 2006 forum, which will focus on Medicaid policy coverage issues of women’s health and impact on the newborn and young child. The key topics are women’s depression and perinatal depression and oral health access for women of childbearing age and specifically during pregnancy (preventive and treatment services are covered in HUSKY, periodontal treatment is not a covered Medicaid service). This is the first in a potential series of roundtables on women’s health.

2004 HUSKY A Children’s Dental and Ambulatory Care Reports: CTVoices

Mary Alice Lee presented the reports

Review of 2001-2004 yearly dental reports presented by CTVoices to the Medicaid Managed Care Council:

CTVoices: Dental Care For HUSKY A Children 2001-2004

*Data from previous CTVoices Reports to Medicaid Council

Observations and discussion:

Dental Access for continuously enrolled children ages 3-20

ü Dental access rates are essentially unchanged from FFY02, with the exception of a 2% increase in preventive care from 2002-2003. The number of children ages 3-20 that have received dental services has increased based on overall enrollment increases.

ü In the 2004 report, higher dental preventive and treatment rates in Hartford as compared to the rest of the population for children ages 5-13 demonstrates the positive impact of school-based health centers (SBHC).

ü Dr. Balaski noted that a project in an East Hartford school had only 6% restorative services for 400 preventive services, suggesting the importance of both dental hygienists and dentists onsite at school clinics; the low restorative rate is indicative of the difficulty of finding dentists outside the school for dental treatment.

ü Preferred One has provided dental screens at Hill House SBHC on one Saturday a month. There was a good “show rate” of members scheduled for the screens. The plan intends to extend this weekend service thru November 2005.

CTVoices: Ambulatory Care For HUSKY A Children 2001-2004

* Data from previous CTVoices Reports to Medicaid Council

Ambulatory Care

ü The number of children ages 2-19 that were continuously enrolled that had ambulatory care increased based on enrollment increases; the percentage remains unchanged from 2002.

ü There was a 5% increase in well care visits in 2004 compared to 2003.

ü 4% of the children had ED care only; of these 29% had a primary care visit of some type in the database (not coded as preventive visit).

ü The number of children with no ambulatory visits has remained at 15%. Cannot determine from the encounter data those HUSKY members with commercial insurance (Medicaid is the payer of last resort); these members may have received ambulatory services under commercial coverage. There are no co-pays for child preventive services in commercial coverage.

ü Data in the national Medical Expenditure Panel comparison of children <200%FPL aged 17 years and under:

o Of the public insurance members, 68% had an ambulatory visits

o 25% had no evidence of care.

The Quality Assurance Subcommittee will meet Thursday December 1 at 9 AM in LOB RM 3800 conference room.