Connecticut
Medicaid Managed Care Council
Quality Assurance Subcomittee
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
Asthma Work Group Meeting Summary
October 18, 2001
Recommendation to the Medicaid Council
Paula Armbruster reviewed the recommendation from the Asthma Work Group to the Medicaid Managed Care Council that requested the managed care organizations identify local vendors in New Haven and Waterbury that carry all basic asthma items, including spacers, nubulizers & accessories and dust mite covers. The MCO's agreed to provide the information to the subcommittee in December rather than November. The Council approved the recommendation with this change.
Department of Public Health Asthma Initiatives
Jennifer Kertannis provided the work group with an update on the following:
· CT Pediatric Asthma Management Initiative implementation phases that communicate the purpose and voluntary use of an asthma treatment plan:
o Phase I: A letter from Commissioner Garcia was sent to health providers (2000) with English and Spanish asthma treatment plan forms, explaining that the voluntary form use is intended to enhance providers' communication and family understanding of the child's asthma treatment plan determined by the primary provider.
o Phase II: School nurses have received a letter and the forms from Commissioner Garcia, emphasizing the important role of school nurses in a child's asthma management.
All but one commercial plan and all Medicaid managed care plans have sent copies of the plan to their enrollees, encouraging them to request their health provider use this form. It was suggested that the HUSKY MCO's might also encourage providers in their networks to use the form.
· DPH is working with Infoline to provide access to a guidance manual that coordinates 8 components of school health, including asthma management from a broad perspective of school environment, medication use, nutrition, and allergies. DPH and Education produced the draft.
· St. Mary's Hospital (SMH) has several small grants from DPH to:
o Develop an asthma pilot linking data systems between the ED and SMH clinic.
o Screen new mothers and families identified at risk for asthma (i. e. family history of asthma, smoking in the home) through the SMH Healthy Families program.
· Four Working groups have been formed subsequent to the DPH Asthma Summit and have met once. The work groups will also identify key issues that impact asthma morbidity and barriers to reducing asthma morbidity, across the State. Medicaid Council Asthma Forum had focused on the HUSKY population, while the DPH work groups will focus on the broader State population affected by asthma.
Managed Care & Asthma Disease Management
At the September meeting Anthem Blue Care responded to the request to review HUSKY plans' asthma disease management program. The group reconfirmed the request that the other three plans present current or proposed asthma disease management programs (DMP) in HUSKY. Information from the National State Medicaid Directors meeting asthma management breakout was given out to the participants. There was a brief discussion of the Wisconsin DHFS Asthma Care Analysis Project, which targeted the improvement of the health status of Medicaid (FFS and MC) recipients through analysis of asthma disease prevalence, service utilization and outcomes measurement. Using this as a model, it would be useful to receive information about CT's HUSKY asthma management programs, identify common impact indicators and outcomes of the DMP interventions, the data from which could be provided to health providers by the MCO as well as aggregate data by managed care plan to DSS. The group agreed to explore this with the MCO's and DSS. The health plans will be invited to present asthma DMP at the November meeting.
Dr. Kamens is co-chair of the Quality of Care Work group of the Commission on the Future of Hospitals that is charged with identifying critical health issues and quality measures that identify best practices and outcomes. Dr. Kamens will share information from this group at future QA meetings.
DME Billing Codes for Asthma
The issue of billing codes for non-medical DME items has been discussed at the MCO/provider asthma meetings. Mr. Linnane and Hilary Silver (DSS) were asked for clarification of the issue. Non- medical items such as dust mite covers are coded under a generic "dump" code that does not identify the specific item. This makes it difficult for MCO's to track use and expenditures of DME asthma items. The HCPC codes, developed by CMS (formerly HCFA) do not include specific codes for such items. Prior Authorization (PA) is often required that may allow the plan to track the use of certain items. Policies for dust mite covers vary among plans. CHNCT provides these without a PA; a prescription from the health provider results in the barriers being mailed out to the family. Anthem BCFP's authorization criteria for the covers was quite restrictive. Sen. Harp addressed concerns about the policy with the ABCFP Director and Medical Director; they are in the process of reviewing and revising the policy and will communicate this to Sen. Harp within 2 weeks.
There were several observations about the MCO/Provider group offered by Mary Alice Lee and others:
· Collaboratively resolving access issues for dust mite barriers is representative of an effective process to reduce barriers in other areas of the program.
· The meeting format has improved communication/understanding between MCO's and providers and could be an ongoing process that targets specific issues. The QA subcommittee has identified specific focus areas that could incorporate this collaborative process.
The managed care organization participation with providers, DSS, and the Council representatives in this meeting format is appreciated, viewed as a crucial strategy in resolving "fixable" problems and enhancing the efficacy of a program that is improving health care delivery to CT's working, lower income families.
Support of the Asthma Treatment Plan
While DPH will address the plan use in broader meeting groups, the HUSKY asthma work group can also support provider use of the form.
Other
James Linnane will be leaving DSS November 1. The full Medicaid Council had expressed appreciation for Mr. Linnane's work in HUSKY and with the Council; the subcommittee thanked Mr. Linnane for his years of work with this subcommittee. He will be greatly missed.
QA Subcommittee Meeting Summary
October 18, 2001
Chair: Paula Armbruster Vice-Chairs: Dottie Needham & Peter Love
Adolescent Health in HUSKY
The subcommittee expressed appreciation for the work of the CHC/CHP in their EPSDT revitalization efforts and Maureen Mullen, Hartford Action Plan, for providing the subcommittee with information on adolescent health issues. The subcommittee agreed to focus on facilitating the use of a risk assessment tool to enhance comprehensive adolescent health screens, a deficit identified in the Qualidigm chart audit. The following was proposed and agreed upon:
Convene a roundtable of representative health provider groups & MCO's to:
· Identify screening tools currently used by health providers, the efficacy and efficiency of the tool, and consideration of a brief tool that providers could recommend for general use.
· Develop methodology to implement provider recommendations. It was suggested that the tool be included in the SDE form (student mandatory physical exam form) for 6th and 10th grade students.
The Roundtable would be held the 2nd week of December, in an evening dinner meeting at CHA. The CHC will participate in this roundtable.
Obesity
· Peter Love provided an overview of the DPH statewide planning initiative on obesity to develop a statewide strategic plan. Mr. Love will share the QA subcommittee's framework for addressing quality issues and the cross cutting themes from the Asthma Forum as a possible framework for the DPH work.
· Senator Harp has asked the QA subcommittee to look into children's obesity and associated services available in HUSKY. Services submitted under an obesity code are not reimbursable in HUSKY A; obesity with co-morbidities would be. Since obesity and Type II diabetes, related to lifestyle factors, is a growing problem in children, particularly in lower income children, the subcommittee recommended that a presentation, sponsored by the Medicaid Council and other stakeholder, be held. The purpose of the forum would be to identify the obesity problem and associated co-morbidities, and the implications and challenges in addressing this preventable public health problem for lower income HUSKY children and other CT children. It was suggested that the target audience be pediatric health providers, commercial and HUSKY managed care organizations and State agencies and organizations involved in addressing this public health issue. A noted Yale researcher, Kelly Brownell, has indicated interest (to Paula Armbruster) in being the keynote speaker of such a forum. Subcommittee members will work with the Council staff to organize this.
Updates
· DSS: Projected State budget deficits are impacting all State agencies' ability to implement portions of the legislation passed in 2001. DCF remains committed to the implementation of Kid Care.
· Qualidigm: Jack Huber introduced Paula Doyle who will take over Debbie Brackett's projects. The status of Qualidigm's ongoing projects will be reviewed at future meetings.
· Children's Health Council: Mary Alice Lee will present a brief overview of the annual ambulatory care report, dental utilization, children's unintentional injuries and EPSDT on-time- visit rates by MCO. These reports will be presented at the CHC's meeting November 5 in Rocky Hill. These meetings are open to those interested in attending. Subcommittee comments regarding these reports:
o Racial disparities for Ambulatory Care have been noted in the report. The CHC will now survey families in an attempt to identify the reasons for underutilization by African Americans newly enrolled in HUSKY. It was suggested that the survey include the families' land of origin. The CHP report on language issues (LEP) show a direct impact by language needs on service utilization as well.
o The Public Health subcommittee has reviewed Hartford's declining dental service utilization; a survey of Hartford dental providers' participation in HUSKY is under way. This survey will assist in determining the reasons for lower utilization that includes MCO data issues, dental service claims reporting problems as well as dental provider HUSKY participation changes.
o On-time EPSDT rates have increased for DCF children for the first time in 6 years; the CHC has worked with DCF and DSS on this. It was noted that FirstChoiceCT/Preferred One has had a 12% drop in on-time EPSDT rates in the 1st 2001 quarter; the CHC has asked DSS to address this with the health plan.
QA Subcommittee Recommendations to DSS for Qualidigm Projects
The subcommittee participants were asked to think about specific recommendations to DSS, communicating suggestion to the Council staff via fax (860) 240-0032 or email (mariette.mccourt@po.state.ct.us) by October 29th. The recommendations will be sent to DSS November 1, 2001. Qualidigm will send the staff an overview of current projects that will then be sent to the committee participants prior to the end of October. The subcommittee informally supported suggestions by Mary Alice Lee (CHC):
· Medical chart review of injuries to capture the E code (cause of the injury) that is not available in the encounter data.
· Medical chart review of the use of adolescent health screen tools and interview of providers regarding their usual risk assessment practices, clinical time spent with the adolescent. This would integrate the CHC, Qualidigm and Subcommittee work.
The next meeting dates: The asthma work group will meet at 9: 30 - 10: 30 AM on Thursday November 20. The QA subcommittee will meet following this at 10: 30 - 12 noon on November 20th. The meetings will be in the LOB RM 2600.