Posts
Growing Pains, Seeing Gains: Improving Youth Transitions
Thursday, August 16th
10:00am – 11:30am
Transitioning from youth to adulthood requires increased responsibility for many areas of life, including managing one’s health. This can be particularly challenging for children with a range of social and health care needs, particularly children with special health care needs. Policymakers from several states, including Georgia and Wisconsin, discuss innovative approaches to support young adults’ transitions to adult health care services and programs through managed care, quality improvement, family engagement, care coordination, and interagency collaboration and cooperation.
This session is supported by the Lucile Packard Foundation for Children’s Health
Moderators
Lori Abramson, Director-Georgia Families 360, Georgia Department of Community Health
Lori Abramson, LCSW is Director of the Georgia Families 360° program at the Georgia Department of Community Health. She ensures that children in foster care, adoption assistance, and youth in the juvenile justice system receive medical, dental, and behadvioral health care without barriers. Lori has 38 years’ experience in clinical practice, advocacy, collaboration building, and the managed care environment. Lori’s professional focus is about leveraging that experience on behalf of Georgia’s children and families.
Donna Bradbury, Associate Commissioner, NYS Office of Mental Health
Donna Bradbury directs the Division of Integrated Community Services for Children and Families at the Office of Mental Health. She oversees all community-based children’s mental health programs in New York State. She is currently leading the effort to transition children’s behavioral health services into Medicaid managed care as part of the larger Medicaid Redesign project.
Prior to state service, Donna worked for twelve years for the Rensselaer County Department of Mental Health. She delivered clinical services to children and their families, served as a consultant to Family Court as well as county-operated human service departments and schools, ran a specialized treatment program which successfully prevented institutional placement for many youth, and assisted in the creation and implementation of several interagency initiatives that resulted in children and their families having easier access to better quality services.
Speakers
Becky Burns, Statewide Coordinator, Wisconsin Children and Youth with Special Health Care Needs Program
Becky’s career centers on supporting children and families whose lives have been affected by unanticipated journeys through the world of disability services. She treasures the opportunities to work with these families whose resilience and growth continues to astound her. With a Master’s of Science in Social Work, she has used her education along with her personal experience of being raised in a family with a child who has a disability to influence her work with families. She has worked in one capacity or another for the state of WI for over 18 years.
Gordon Lee, Health Program Administrator, KY Office for Children with Special Health Care Needs
Lee holds a Master of Public Administration (MPA) and a Bachelor of Health Science in Health Administration. He is employed by the Office for Children with Special Health Care Needs (OCSHCN) where he carries out the duties of the agency’s Transition Administrator. Lee works with children, adolescents, families, support groups, service providers and OCSHCN staff to help ensure that Kentucky’s children with disabilities are prepared to successfully transition from pediatric to adult health care, from school to work, and from home to independent living. Lee coordinates the activities of the OCSHCN’s Youth and Parent Advisory Councils.
Peggy McManus, President, The National Alliance to Advance Adolescent Health
Peggy McManus is President of The National Alliance to Advance Adolescent Health and Co-Director of Got Transition. With Dr. White, she led the revision of the Six Core Elements of Health Care Transition, developed new transition quality improvement and consumer feedback measurement tools, published systematic reviews on transition outcomes and measures, and published extensively on transition quality improvement, payment options, state Title V transition efforts, and the status of transition preparation in the US.
Georgia
In Georgia:
- As of July 1, 2011, there were 1,548,090 beneficiaries enrolled in Georgia’s Medicaid program. Of these, 1,413,643 were enrolled in managed care. Managed care organizations (called Care Management Organizations in Georgia, or CMOs) are responsible for providing physical health, mental health, and substance abuse benefits to most Medicaid enrollees, including children.
- A Home and Community-Based Services waiver, the Georgia Pediatric Program, provides services to medically frail children whose needs cross systems.
As of 2012, 1,279,084 individuals were eligible for Georgia’s Health Check program (also known as the Early Periodic Screening, Diagnostic and Treatment benefit, or EPSDT). According to CMS data from 2012, Georgia achieved an EPSDT screening ratio of 67% and a participation ratio of 54%. 594,658 children received dental services of any kind, with 558,401 receiving preventive dental services.
Last updated February 2014.
| Medical Necessity |
The Georgia Code (at § 49-4-169.1) defines medically necessary services for children as “services or treatments that are prescribed by a physician or other licensed practitioner, and which, pursuant to the EPSDT Program, diagnose or correct or ameliorate defects, physical and mental illnesses, and health conditions, whether or not such services are in the state plan.”
It further specifies that “’Correct or ameliorate’ means to improve or maintain a child’s health in the best condition possible, compensate for a health problem, prevent it from worsening, prevent the development of additional health problems, or improve or maintain a child’s overall health, even if treatment or services will not cure the recipient’s overall health.”
|
| Initiatives to Improve Access |
Managed care organizations (MCOs) are required to provide primary care providers with a monthly list of Health Check eligible children who are not in compliance with the state’s periodicity schedule; the MCO or provider must then contact the child’s family to schedule an appointment.
MCOs are eligible for performance incentive payments based on the percentage of Health Check well-child visits and screens achieved above a minimum 80% threshold.
|
| Reporting & Data Collection |
Managed care organizations (MCOs) must select certain care elements to monitor in physician profiles; one possible element is preventive care, which includes Medicaid well-child visits.
MCO contracts also require the MCO to submit an EPSDT report that, at a minimum, lists:
MCOs must establish internal tracking systems registering compliance with the state’s Health Check requirements. These systems must track:
External Quality Review reports track several performance measures related to Health Check Services, including children’s access to primary care providers, well-child visits, and others.
|
| Behavioral Health |
Screening
Georgia requires that primary care providers performance developmental screenings for children at 9 months, 18 months, and 30 months. Providers must use standardized tools, though the Health Check handbook does not recommend particular screening tools.
Autism screenings are required at 18 months and 24 months and the state recommends the MCHAT screening tool
Alcohol and drug use assessments are required at all adolescent well visits, but standardized screening instruments are only required when a parent raises a concern.
CHIPRA Quality Demonstration
Georgia partnered with Maryland and Wyoming on a CMS CHIPRA Quality Demonstration Grant to implement a project called “Care Management Entities for Children With Serious Behavioral Health Needs.”
The grant will support the development of a Care Management Entity provider model to improve the service delivery to Medicaid and CHIP enrolled children with serious behavioral health disorders. Stated goals are to:
|
| Support to Providers and Families |
Georgia’s managed care plans are required to create Medicaid provider manuals that describe the Medicaid benefit for children and adolescents. Some have created dedicated Health Check provider handbooks to inform providers of the benefit.
Managed care plans also have Health Check websites to inform beneficiaries about the benefit. |
| Care Coordination |
|
| Oral Health |
Primary care providers can bill (using code D1206) for applying fluoride varnish to a Medicaid-enrolled child. |
Georgia
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@nashp.org.
Last updated: October 2012
State Documentation of Racial and Ethnic Health Disparities to Inform Strategic Action
This report, prepared by NASHP for the federal Agency for Healthcare Research and Quality, summarizes how leading states analyze state and federal race/ethnicity data in strategic plans and reports aimed at reducing racial and ethnic disparities in health status and health care. It features Colorado, Connecticut, Georgia, Maryland, New Jersey, New Mexico, Rhode Island, and Utah, but also notes activity in Arizona, California, Massachusetts, Michigan, North Carolina, Ohio, and Virginia. Lessons from leading states can provide guidance for others exploring ways to launch or enhance health equity, consumer engagement, quality improvement, or cost containment initiatives.
Read full report here.
State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities
This report summarizes how leading states that participate in the Healthcare Cost and Utilization Project (HCUP) and their clients use hospital discharge data on patient race/ethnicity to inform state health care disparities reduction activities. The report features California, Florida, Massachusetts, Rhode Island, and Wisconsin HCUP Partners, but also notes activity in Connecticut, Georgia, New Jersey, and South Carolina. Partner States’ experiences demonstrate that patient race/ethnicity data are an important tool for informing state initiatives and producing policy- and practice-relevant publications to support health equity.
| State Use of Hospital Discharge Databases to Reduce Racial & Ethnic Disparities.pdf | 204.8 KB |
Georgia
The available HIE Strategic Plan from Georgia is a pre-ARRA planning document that enumerates many of the objectives for health information exchange in Georgia that are being pursued.
Georgia – Medical Homes
We have no information on medical home activity that meets the following criteria: (1) program implementation (or major expansion or improvement) in 2006 or later; (2) Medicaid or CHIP agency participation (not necessarily leadership); (3) explicitly intended to advance medical homes for Medicaid or CHIP participants; and (4) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
Last Updated: April 2014
Care Coordination for People with Chronic Conditions
This paper explores the components of care coordination and a sample of state initiatives that bridge the health and supportive systems.
| care_coordination.pdf | 341.3 KB |
Coordinating Care for the Chronically Ill: How Do We Get There from Here?
This paper, a product of the National Academy for State Health Policy’s Flood Tide Forum series, is designed to identify innovative strategies to improve care coordination for the chronically ill. It reviews data on the incidence and costs of chronic conditions, summarizes the literature on care coordination, and highlights state programs.
| care_coordination_forum.pdf | 434.6 KB |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
