“Next Steps for ME CHIP” Maine Child Health Improvement Partnership (ME CHIP) Advisory Group Friday, February 13, 2015, 12-2 pm at QC ME CHIP and the First STEPS Learning Initiative is part of the Maine Improving Health Outcomes for Children demonstration grant awarded by the Centers for Medicare and Medicaid Services to MaineCare in partnership with the Maine Center for Disease Control and Prevention, the Muskie School of Public Service at the University of Southern Maine, Vermont’s Medicaid Program, and the University of Vermont. Maine Quality Counts, Webinar/Phone Available Webinar: Audio: , Access Code: # 1

Maine Child Health Improvement Partnership (ME CHIP) Mission To optimize the health of Maine children by initiating and supporting measurement-based efforts to enhance child health care by fostering public/private partnerships. Vision All practices providing health care to children will have the skills, support, and opportunities for collaborative learning needed to deliver high quality health care. ME CHIP Meeting 2/13/15 2 ME CHIP is part of the National Improvement Partnership Network (NIPN)

ME CHIP Agenda 3 12:00Welcome and review minutes 12:05Input on strategic priorities/MOC 12:25Input on potential future work on Adolescent Medicine 1:05Follow-up on PTE from December 1:15 Planning for Dr. Garner’s visit 1:45Next STEPS 2:00 Adjourn ME CHIP Meeting 2/13/15

ME CHIP Participants 4ME CHIP Meeting 2/13/15

Discussion of What is Next for ME CHIP- Getting Your Input Review strategic priorities from March 2014 Are their gaps around children’s health care that you have identified in the last year that we should be looking at as a group? Ideas for future MOC projects Relooking at ME CHIP Advisory Group Structure- are we missing key stakeholders? ME CHIP Meeting 2/13/155

Prevention (Age 0-5) Lead/Anemia Screening Oral Health of Young Children Adolescent Medicine Teen Depression Screening Social Determinants of Health Adverse Childhood Events Care Coordination Transitions Drug Affected Infants Structure/Process Metrics Chronic Care Asthma ADHD ME CHIP Priority Areas 6ME CHIP Meeting 2/13/15

Input on Planning Potential Future Work on Adolescent Medicine ME CHIP Meeting 2/13/157 Identify overarching scope, goals, deliverables Problem/issue being addressed Aims statement Goals Deliverables Scope ID customers/stakeholders Customer/stakeholder needs Environmental scan Integration/alignment w/ other programs Constraints, risks

Input on Potential Future Work on Adolescent Medicine Potential Aim: Improve the health of Maine’s children and adolescents by increasing rates of the following by 10%: Vaccines by age 13 as recommended by the American College of Immunization Practices and the US CDC: Tdap (tetanus, diphtheria, pertussis); MCV (meningococcal disease); and HPV (human papillomavirus) Adolescent well visits Teen depression and substance abuse screening ME CHIP Meeting 2/13/158

Baseline Data ME CHIP Meeting 2/13/159 Hospital Service Area In ME Rate of Adolescent Well Care Visits Hospital Service Area In NH or VT Portland, ME44%61%Manchester, NH Bangor, ME44%55%Lebanon, NH Lewiston, ME43%54%Nashua, NH Augusta, ME36%54%Dover, NH 50%Concord, NH 46%Burlington, VT Table 1. Rates of Adolescent Well Care Visits Based on All Payer HEDIS Data as Reported in the Dartmouth Atlas of Children’s Health Care of Northern New England [1] [1] [1] The Dartmouth Atlas of Children’s Health Care in Northern New England, December 2013, P. 32.

Baseline Data- Well Visits ME CHIP Meeting 2/13/1510 Improving Health Outcomes for Children (IHOC) Summary of Pediatric Quality Measures For Children Enrolled in MaineCare FFY 2009-FFY 2013

Baseline Data Immunization Type 2011 Baseline Rate 2013 Rate Tdap65.9%80.4% (+13.8%) MCV59.8%78.9% (+18.5%) HPV-girls17%23.3% (+5.9%) HPV-boys5.6%8.9% (+3.3%) ME CHIP Meeting 2/13/1511 As reported in 2014 American Health Rankings report, annual NIS data shows that: Adolescent immunizations (13-17 year old) rate increased from 59.5% to 65% in 2012 and to 66.7% in First STEPS Rates in 21 practices: Table 1. Adolescent Immunization Rates: First STEPS ( ) (Based on 21 demonstration sites in ImmPact; age 13 measures) [1] [1] Not able to measure this rate at the beginning of the project; this baseline was determined as of December 2012

Baseline Data- Chlamydia Screening ME CHIP Meeting 2/13/1512 Improving Health Outcomes for Children (IHOC) Summary of Pediatric Quality Measures For Children Enrolled in MaineCare FFY 2009-FFY 2013

What Baseline Data do you want to collect? ME CHIP Meeting 2/13/1513 Depression screening data Substance Use screening

Potential Timeline Planning – July-October 15 Recruit- Oct 15- Jan 2016 Initial ACES training- Oct/Nov 2015 with MRBN Initial Immunization training 3 sites in Nov/Dec by MH (Bangor, Augusta and one at another site; MH has done several trainings in Portland, Pen Bay and Biddeford areas) Learning Collaborative- 2 phases over 6-8 months starting in Spring 2016 ME CHIP Meeting 2/13/1514

Ideas for Topics ME CHIP Meeting 2/13/1515 Engagement strategies with adolescents and their families. Social media Community and school connections Teen advisory groups Assembling practice teams, school nurses, and families Health screenings Depression Suicide risk screening HPV and adolescent immunizations Improving interactions and resilience Substance use screening Violence Texting Bullying Sexual identity Confidentiality

QI Needs for Project “Strengths, Weaknesses, Opportunities, and Threats (SWOT)” analysis using baseline immunizations data, the office systems survey results and team assessment results. Help with PDSA Cycles- test vs. task Mapping out office workflows On site vs virtual coaching- need for health system support ME CHIP Meeting 2/13/1516

Potential Partners ME CHIP Meeting 2/13/1517 MaineCare MAAP, MAFP, MOA CDS School Nurses Parents and teens DOE MaineHealth/Vax Maine Kids Muskie Health Systems MRBN

Follow-up on PTE from December – ME CHIP recommendations from December meeting will be presented to the February 26 th PTE Clinical Steering group from 9-9:30 ME CHIP Meeting 2/13/1518

ME CHIP Recommendations to PTE on Immunizations Change Immunizations Ratings to Good > 45 Points, Better > 70 Points, Best > 90 Points Adjust individual measures points so that total points equal 100 Immunizations: Change to 3.25 points each measure (from 3.5) Update first target to 2013 NIS Maine data – at 24 months and update second target to 2013 Maine ImmPact data for First STEPS practices for 75 th percentile Cap individual immunization rates at 94% (Maine kindergarten philosophical exemption rate is 5.1%) The ME CHIP vote in December 2014 is for recommendations for the PTE Clinician/Provider Steering Group. They will need to adopt changes and set timeline for when they go into effect. ME CHIP Meeting 2/13/1519

ME CHIP recommendations to PTE on asthma Change Asthma Ratings to Good > 50 Points, Better > 70 Points, Best > 85 Points Asthma (Change to 13.5 for first 6 measures and keep 10 for BMI%); Change population based reporting for 9 points to mirror immunizations scoring PTE should thoroughly review asthma metrics in Summer 2015 The vote in December was for recommendations for the PTE Clinician/Provider Steering Group. They will need to adopt changes and set timeline for when they go into effect. ME CHIP Meeting 2/13/1520

Dr. Garner’s Visit- May 1 st, 1-4 pm at Senator How to incorporate early brain and child development and ACES into policy and QI work Who is attending Structure of Meeting- how to optimize time What do we want to leave with? Action Plan ME CHIP Meeting 2/13/1521

3 Community Pilots selected to work across early childhood sectors on developmental screening- first set of trainings completed; initial data due Feb 15th 1) Mid-Coast area 2) Waterville Area 3) Bangor area Exploring ASQ online- way to link screenings across the sectors, EMRs, and parents can complete prior to visit online Next tri-Community training is May 6th DSI Work in : “Completing the Loop” 22 ME CHIP Meeting 2/13/15

Next Steps ME CHIP Meeting 2/13/1523

Future Meeting Dates Future Meeting Dates (2 nd Friday, alternating in person at QC and by phone) -Friday, May 1, 2015, 1-4 with Dr. Garner at the Senator Inn, Augusta -Friday, June 12, 2015, 12-2 in person -Friday, August 14, 2015, 1-2 by phone -Friday, October 9, 2015, in person -Friday, December 11, 2015, 1-2 by phone 24ME CHIP Meeting 2/13/15

ME CHIP Contact Information Amy Belisle, MD, Director of Child Health Quality Improvement, Maine Quality Counts, / Sue Butts-Dion, First STEPS Program Manager, Quality Specialist, Maine Quality Counts, / Deb Gilbert, QC for Kids Administrative Coordinator, / x ME CHIP Meeting 2/13/15