The National Evaluation of the CHIPRA Quality Demonstration Grant Program: Spotlight on Colorado

Publication Year: 2015
Patient Need Addressed: Behavioral health, Chronic Conditions
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Best practices, Service redesign
Type of Literature: Grey

This brief highlights the major strategies, lessons learned, and outcomes from Colorado’s experience in the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). 

Colorado’s Goals: Work with school-based health centers to improve care for adolescents by 1) implementing new quality improvement process 2) implementing an electronic screening tool 3) engaging youth in care 4) promoting the patient-centered medical home

Insights Results

Overview of model

  • Colorado hired quality improvement coaches to help school-based health centers (SBHCs) improve the delivery and documentation of preventative services recommended by the Early and Periodic Screening Diagnosis Treatment (EPSDT) standards and to improve other QI topics (e.g. pediatric obesity, depression and anxiety, sexual health and immunization)
  • The percent age of adolescents in SBHCs with all EPSDT-recommended services documented increased from 33% to 72% during the demonstration
  • Electronic questionnaires were used to screen adolescents for social and behavioral risk factors; students responded more positively to electronic rather than previous paper surveys and results were used to identify risk factors that required follow up
  • All participating SBHCs became recognized medical homes by completing the Medical Home Index form and by creating a tracking system for referrals, coordinating with local hospitals and developing a list of community resources for families

    Key takeaways/implications

    • Partnerships: Colorado partnered with New Mexico to design and implement demonstration across both states
    • Challenges: 1) SBHCs’ EHR problems (ex. poor internet connection); 2) A general lack of familiarity with QI; 3) Staff turnover, competing priorities for staff time; and 4) Limited financial resources made processes to monitor and improve quality more complicated