Quality Measurement in Immunization

Presentation to: National Immunization Conference Presented by: Janice Carson, MD, Deputy Director

Performance, Quality and Outcomes

Date: 9/29/140

Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

1

Overview Overview Medicaid and CHIP Services for Children – the  Medicaid and CHIP Services for Children – the EPSDT Benefit EPSDT Benefit Measuring Service Delivery and Quality - CFR  Measuring Service Delivery and Quality Requirements and Performance Reporting  CFR Requirements and Performance Reporting Performance Improvement Activities  Performance Improvement Activities Questions  Summary  Questions 2

EPSDT Benefit • Available for all Medicaideligible children birth to twenty-one (21) years of age • Available for all eligible PeachCare for Kids® members, Georgia’s standalone CHIP program, from birth to nineteen (19) years of age.

Majority of all Georgia Medicaid and CHIP members are under age 21. 3

EPSDT Benefit • Section 1905(r) of the Social Security Act states the Georgia’s EPSDT Benefit must make available: – Screening Services -- Screening services must include all of the following services: – Comprehensive health and developmental history -- (including assessment of both physical and mental health development); – Comprehensive unclothed physical exam -(unclothed means to the extent necessary to conduct a full, age-appropriate examination); 4

EPDST Benefit – Appropriate immunizations based on ACIP guidelines. Vaccines available for Medicaid members via Vaccines for Children (VFC) program – Appropriate Laboratory Tests – Lead Toxicity Screening – Health Education – including anticipatory guidance. Health Education should assist with understanding what to expect relative to the child's development and provide information about the benefits of healthy lifestyles and practices, vaccine preventable diseases, as well as accident and disease prevention; 5

EPSDT Benefit • Vision Services -- Including diagnosis and treatment for defects in vision; and eyeglasses. Vision services must be provided according to the periodicity schedule and at other intervals as medically necessary; • Dental Services – Including relief of pain and infections, restoration of teeth and maintenance of dental health. Services are provided in accordance with the AAPD dental periodicity schedule. • Hearing Services – including diagnosis and treatment of hearing problems • Other Necessary Health Care to correct or ameliorate defects, and physical and mental illnesses and conditions discovered by the screening services. 6

2014 Bright Futures Schedule

7

Measuring Service Delivery and Quality • Quality Assessment and Performance Improvement (QAPI) Program for Medicaid Managed Care 42CFR438 Subpart D – Requires states to develop a quality assessment and performance improvement (QAPI) strategy to assess and improve the quality of managed care services; – Must submit initial strategy, any significant revisions and regular reports about the implementation and effectiveness of the strategy to CMS.

8

Measuring Service Delivery and Quality • QAPI Program must: – Have procedures that: • assess quality and appropriateness of care • regularly monitor and evaluate compliance w/standards

– Include: • national performance measures developed by CMS • provisions for an annual external independent quality review of quality outcomes, timeliness of and access to services

9

Measuring Quality – The Core Sets of Measures

Annual voluntary reporting to CMS 10

Immunization Measures within the Core Sets • CHIPRA Immunization Measures: members must meet eligibility requirements - no more than 30 day break in eligibility during reporting period – Childhood Immunization Status Combo 10 – children who turned 2 in measurement year who received the following vaccines: • 4 DTaP, 3 IPV, 1 MMR, 3 HiB, 3 HepB, 1 VZV, 4 PCV, 1 HepA, 2 – 3 RV, and 2 Influenza • We track Combo 3 also which does not include the HepA, RV or Influenza vaccines

– Immunization Status for Adolescents – 13 year olds w/ 1 MCV and 1 Tdap or Td by 13th birthday – HPV Vaccine for Female Adolescents – 13 year olds who had 3 doses of HPV by 13th birthday

• Adult Core Set of Measures – Flu Vaccinations for Adults Ages 18 to 64 – generated using the CAHPS Survey 11

Performance Reporting in Georgia Eligibility Data Claims Data

PH GRITS Data

HEDIS Software

Medical Record Reviews

Immunization Rates 12

Performance Reporting in Georgia Statewide Data

Childhood Immunizations

13

Performance Reporting in Georgia • Low HepB series rates – Checked the immunization registry data – first HepB vaccine given in hospital not always uploaded to registry – Checked claims data • Hospitals not using codes specified in HEDIS specifications – Inpatient hospitals can’t use CPT codes (90744) defined in the specifications so the birth dose of HepB is coded as ICD 9 code V05.3 with the ICD -9-CM Procedure Code of 99.55. Not acceptable for HEDIS software.

– Contacted NCQA, they are aware of issue. Will not change specifications at this time. 14

Performance Reporting in Georgia CMO CY2012 and CY2013 CHIPRA Immunization Measures

CMO 1 - 2012

CMO 1 - 2013

CMO 2 - 2012

CMO 2 - 2013

CMO 3 - 2012

CMO 3 - 2013

82.64% Hybrid Combo 3

80.56% Hybrid Combo 3

76.74% Hybrid Combo 3

79.17% Hybrid Combo 3

78.83% Hybrid Combo 3

84.95% Hybrid Combo 3

16.71%

21.53%

17.82%

21.53%

19.95%

21.30%

71.43% Hybrid

78.70%

71.30% Hybrid

78.01% Hybrid

70.98% Hybrid

74.59% Hybrid

The Well Child Visit

Childhood Immunization Status - Combo 3: 2 year olds had 4 DTaP, 3 IPV, 1 MMR, 3 HiB, 3 Hep B, 1 VZV, 4 PCV

Human Papillomavirus Vaccine for Female Adolescents – 13 year old girls who had 3 doses of HPV by their 13th birthday

Immunization for Adolescents - Combo 1: 13 year olds who had meningococcal vaccine and 1 Tdap or 1 Td

15

Performance Reporting in Georgia • Flu Vaccinations for Adults Ages 18 to 64 – The percentage of Medicaid enrollees who received an influenza vaccination between July 1 of the measurement year and the date when the CAHPS 5.0H adult survey was completed. New spec for CY 2013. – CMO 1: 33% with 18% response rate (270) – CMO 2: 27.1% with 26.4% response rate (468) – CMO 3: 23.7% with 30% response rate (472)

16

Performance Improvement Activities • Ongoing collaboration between GAAAP, GA AAFP, DCH, and managed care plans to drive performance improvement. – Monthly calls providing feedback from providers.

• Collaboration with DPH Immunization program • Managed care plans have implemented performance improvement projects – Use incentives to drive members into care – Care Gap reports to providers – Use incentives to drive practitioners to increase outreach to noncompliant members 17

Summary • EPSDT benefit allows Medicaid and PeachCare for Kids® members access to immunizations at their PCPs’ offices and public health departments. • We have seen steady improvement in Georgia’s childhood immunization rates. Will look for improvements in the influenza rates. • Continue to monitor the rate generation process so that rates accurately reflect immunization coverage • Ongoing collaborations to drive improvements 18

Questions

19