Rachel Copeland, MDHHS Debra Darling, Institute for Health Policy, MSU 1
• Learning Goals: o Describe MHP population health and quality improvement initiatives o Provide an overview of required performance improvement measures o Identify opportunities for collaboration 2
• Managed Care since 1997 • New Medicaid Contract: January 2016 o 11 Medicaid Health Plans • Population health framework • Focus on evidence and value-based care delivery models • Service areas based on Prosperity Regions 3
• Population Health Management Goal: To reduce racial/ethnic disparities • Implement a program and other procedures to address social determinants of health and Health Equity • Two Healthcare Effectiveness Data and Information Set (HEDIS)measures selected for disparity reduction: o Postpartum Care o Childhood Immunization Status – Combo 3 4
• Chlamydia Screening o Largest racial/ethnic disparity of the Health Equity Project last three years • Goal: To describe and implement programs/efforts to improve screening and treatment rates, and narrow health disparities o Target: Men ages 16-18 and women ages 16-24 years o Data analysis by race/ethnicity/gender 5
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Chlamydia ydia Screening ning by Race/Ethnic hnicit ity y 2012-20 2015 15 78.0% White 76.0% 74.0% 72.0% African American 70.0% 68.0% Hispanic/Latino 66.0% 64.0% 62.0% Michigan Medicaid All Managed Care 60.0% Plans 58.0% 56.0% National Medicaid 50th Percentile 54.0% 52.0% 2012 2013 2014 2015 8
• Participation in MDHHS approved community-lead initiatives to improve population health in each service area region • MHPs have identified some of the following social determinants of health: family, transportation, housing stability 9
• Emergency Department Utilization o Develop an in-depth understanding of ED utilization o Design interventions that move toward systematic approach to address complex issues impacting utilization • Intervention focus: high-volume, high-risk, or problem- prone areas • Goals: To improve health outcomes; enhance coordination of services; partner with non-traditional healthcare providers; increased cost-effectiveness 10
• Collaboration and integration between Medicaid Health Plans (MHPs) and Pre-paid Inpatient Health Plans (PIHPs) • Joint care management processes • Shared performance metrics o Follow-up after Hospitalization for Mental Health Illness within 30 days 11
Women’s Health: Breast Cancer Screening Cervical Cancer Screening Chlamydia Screening Prenatal Care Postpartum Care Low Birth Weight Low-Risk Cesarean Section Adolescent Immunizations Smoking Cessation Strategies: Medical Assistance with Smoking and Tobacco Use (Consumer Assessment of Healthcare Providers and Systems-CAHPS) 12
Post-Partum Care, By Race/Ethnicity Michigan Medicaid All Managed Care Plans HEDIS 2015 100% 54.9% 64.3% 75% 63.2% 51.6% 61.6% Percentage 57.4% 48.2% 50% 25% 0% AI/AN Asian/NH/OPI AA Hispanic Other/ Multiracial White All Plan n = 91 n = 384 n = 10460 n = 1580 n = 51 n = 19465 n = 33342 Race/Ethnicity 13
• Childhood Immunizations • Well-Child and Adolescent Well Care Visits • Access to Primary Care Visits • Chronic Conditions (Diabetes & Asthma) • Child and Adult BMI • Blood Lead 14
• In July 2014, Center for Medicaid and CHIP Services (CMCS) launched the Maternal and Infant Health Initiative, in collaboration with states to: o Increase the rate and content of postpartum visits o Increase the use of effective methods of contraception o Supports collection and reporting of data to CMCS on a developmental quality measure o Measure assesses progress on the goal to increase the use of effective methods of contraception 15
• Assessment of MHP Family Planning Services • Survey of primary care and OB/GYN provider regarding reproductive counseling and Long- Acting Reversible Contraception (LARCs) - Pending • Pilot in 3-4 practices related to reproductive health counseling 16
FAMIL MILY PLAN ANNI NING NG METH THODS DS Covered ered? Notes tes MOST OST EFFECTIVE, FECTIVE, REVERSIBL VERSIBLE Lon ong g Acti ting, ng, Rever ersibl sible e Con ontracep traceptio ion (LAR ARC) C) Lon ong g Acting ing Impla plantabl able e Rod ods Intrau rauterin terine e Device, vice, Hormo rmone ne Releas leasin ing Intrau rauterin terine e Device, vice, Copper pper MOST OST EFFECT FECTIV IVE, E, PERMA MANENT ENT Female emale Steri rili lizati zation Male le Ste teril ilizat zatio ion MODERA DERATELY TELY EFFECTIVE FECTIVE Lon ong g Acti ting ng Hormo rmone e Injectio jection Vagin inal al Ring ing Oral al Contraceptiv ontraceptives es "The he Pill" l" 17
• Population Health • Community Collaboration • Health Equity o Low Birth Weight (LBW) by prosperity region • Performance Measurement • Other: o MHP Performance Improvement Project (PIP): Timeliness of Prenatal Care 18
Medicaid Managed Care Sample Contract • o http://www.michigan.gov/documents/contract_7696_7.pdf Minority Health Equity Report • o http://www.michigan.gov/documents/mdhhs/2016_Health_Equity_Base_Report_Dr aft_3.17.17_R eadyToSubmit_UpdatedGraphic_572318_7.pdf HEDIS Aggregate Report • o http://www.michigan.gov/documents/mdhhs/MI2016_HEDIS- Aggregate_F1_552834_7.pdf Federal Contraception pages • o https://www.medicaid.gov/medicaid/quality-of-care/improvement- initiatives/maternal-and-infant-health/contraception/index.html o https://www.medicaid.gov/medicaid/quality-of-care/improvement- initiatives/maternal-and-infant-health/ 19
Rachel Copeland CopelandR1@michigan.gov 517-284-1160 Debbie Darling Debra.darling@hc.msu.edu 517-432-9822 20
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