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Colorado Children’s Healthcare Access Program (CCHAP)
15 Support Services For Colorado Practices
That Provide a Medical Home for Medicaid and CHP+ Children
Administrative Supports
Enhanced Provider Reimbursement
Enrollment Specialist and help with enrollment and eligibility
Technical assistance regarding business processes as they relate to Medicaid and CHP+
Practice administrators network
Family Supports and Clinical Services
Social Services Support
Mental Health Services
Case Management/Care Coordination
After-hours Telephone Care
Immunizations
Transportation
Diversity Training
Medical Spanish Interpretation Courses for Office Staff
Continuous Quality Improvement (CQI) / Best Practices
Provider Resource Hotline For Children with Special Health Care Needs
Parent Advisory Group
Administrative Supports
Enhanced Provider Reimbursement – CCHAP and the Colorado Department of Health Care Policy and Financing (HCPF), which oversees state Medicaid, are partnering to implement a Primary Care Pay-for-Performance demonstration program that will provide the current 28 CCHAP practices with a supplemental fee, in addition to customary reimbursements for patient visits, to entice and reward completion of preventive care services for the Medicaid patients they serve. This fee provides a pay-for-performance incentive for each Medicaid child in the practice whose annual preventive healthcare is completed. Additional pay for performance will depend on the practice’s performance on measures like: ED utilization rates, cost-per-child, immunization rates, rate of providing preventive care and other quality indicators. A similar arrangement with Colorado Access (the non-profit managed care company that administers CHP+) will provide CCHAP practices with a case management fee based on performance on quality of care indicators for the CHP+ children they serve. As we expand to support other practices, we anticipate developing similar enhanced reimbursement by working with Medicaid managed care organizations.
Enrollment Specialist and help with enrollment and eligibility – CCHAP, HCPF and The Children’s Hospital are partnering to assign an enrollment specialist, based at The Children’s Hospital, who has direct access to the CBMS computerized eligibility system (which determines eligibility for Medicaid and CHP+). This person will be available to CCHAP practices to assist with enrollment-related issues for CCHAP children. CCHAP also trains practices to work around systems problems in eligibility and enrollment of Medicaid and CHP+ children. In addition, HCPF continues to make staff available to help CCHAP practices with enrollment problems.
Technical assistance regarding business processes as they relate to Medicaid and CHP+ - CCHAP provides technical assistance to practices to train office staff in the best ways to code and process claims and deal with Medicaid and CHP+ issues like: eligibility determination, authorizations, referrals, billing, claims tracking and verification. In addition, CCHAP provides monthly updates through its newsletter for practices on legitimate ways to enhance reimbursement through improved claims processing and coding.
Practice administrators network - CCHAP has developed a Practice Manager’s Network with regular meetings at which all 28 practice managers provide information, lessons learned and support for one another in the care of low income children. This has been very popular and well-attended.
Family Supports and Clinical Services
Social Services Support - In order to adapt to the expansion, CCHAP has hired a resource coordinator (assistant to the social worker). Supervised by the social worker, the resource coordinator works with families to problem-solve around the many psycho-social issues that influence families’ abilities to access and appropriately utilize recommended health care services, e.g., financial assistance, housing, food/nutrition, day care, substance abuse, family violence, parenting skills, smoking cessation, legal problems, and transportation. The social worker and resource coordinator also train practice staff to handle many common family needs directly.
Mental Health Services - CCHAP continues to develop new service delivery models to improve child access to mental health services. CCHAP has formalized its current arrangement with the metro area behavioral health organizations and mental health centers to: 1) improve access for children, 2) improve communication regarding patients between mental health providers and the practices, and 3) relax its diagnosis-driven eligibility criteria and instead accept all CCHAP provider referrals for child behavioral health assessments. CCHAP has worked out a system with the BHOs and Mental Health Centers for a Child Psychiatrist to be available for telephone consultation on all CCHAP patients in CCHAP practices. CCHAP is also implementing a new mental health screening tool in CCHAP practices and continues to provide training opportunities for CCHAP providers on the PCPs role in treatment and referral. CCHAP has arranged for mental health providers to provide care for Medicaid and CHP+ children within the CCHAP practice offices in five locations, with plans for several more.
Case Management/Care Coordination - CCHAP continues a multi-pronged approach to case management that includes practice-based strategies, staff training, and collaboration with community organizations and state agencies. For example, CCHAP utilizes the CCHAP resource coordinator and HCPF care coordinators to work closely with families that overutilize emergency departments or recurrently miss office appointments (no-shows) to address the underlying reasons. CCHAP now works with the Pulmonary Division at Children’s Hospital to make asthma nurse case manager available to families, whose Medicaid and CHP+ child’s asthma is not well controlled. The nurse educates the family and patient regarding their specific asthma care plan and follows them closely until health outcomes are improved.
After-hours Telephone Care - CCHAP works with HCPF and Colorado Access to implement an incentive system that rewards practices that provide physician availability for after-hours telephone care. Client-level education efforts about appropriate and inappropriate ED use has also been implemented.
Immunizations - All CCHAP-affiliated practices are required to participate in the CIIS statewide immunization registry to improve documentation of immunization status, to communicate between practices, and to implement client and provider reminders to improve immunization rates. CCHAP and CIIS assist the practice in doing reminder recall to get all children in for needed immunizations and preventive care. As a result, immunization rates for Medicaid and CHP+ children in CCHAP practices resemble immunization rates for commercially insured children and are dramatically higher than unassigned Medicaid children.
Transportation - CCHAP practices continue to refer Medicaid clients to Logisticare to provide non-urgent transportation. In addition, CCHAP continues to provide cab vouchers to assist CHP+ clients for whom transportation is not a covered benefit, or to Medicaid patients in emergency situations.
Diversity Training - CCHAP continues to refine the Socio-cultural Training Program (STeP) that targets all CCHAP practice providers and staff to develop knowledge, skills and attitudes needed to provide culturally responsive care. The training focuses on issues identified by families and practices and offers in-office training, workshops, teleconferences, a monthly newsletter and web-based training for all Colorado pediatric practices.
Medical Spanish Interpretation Courses for Office Staff - CCHAP now works with International Language Services, a Spanish interpretation training program, to economically provide training for bilingual practice staff to enable them to develop interpretation skills equivalent to a polished, professional interpreter. We utilize a weekly teleconference and web-based training materials. All of the participants have been “highly satisfied.”
Continuous Quality Improvement (CQI) / Best Practices – CCHAP provides a PhD level CQI expert to assist practices in assessing and improving office processes to improve efficiency and quality of health outcomes for their patients. The areas of focus in 2008 will be to increase the percentage of Medicaid and CHP+ children in the practices who are fully immunized and who receive complete preventive care, increase the percent of asthmatics whose asthma is under optimal control, increase the percentage of children receiving developmental screening, decrease the number of children being taken inappropriately to Emergency Departments and decrease the number of missed appointments (no-shows).
Provider Resource Hotline For Children with Special Health Care Needs - CCHAP has worked closely with Family Voices to create a hotline for primary care practices that helps providers determine the most appropriate resources for their specific children with chronic illness or special needs and helps link families with all of those resources.
Parent Advisory Group - CCHAP is in the process of developing a parent advisory group, made up of parents whose children are on Medicaid or CHP+, parents representing each of Colorado’s larger minority groups and parents of special needs children. These parents will provide us with their perspective on receiving care in a private practice and advice on what practices can do to adapt care to the needs of low income families, minorities and special needs children.
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