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

Publication Year: 2018
Patient Need Addressed: Care Coordination/Management
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Best practices, Technology/innovation
Type of Literature: Grey

This brief highlights the major strategies, lessons learned, and outcomes from Pennsylvania’s experience from February 2010 to February 2016 with the quality demonstration funded by the Centers for Medicare & Medicaid Services (CMS) through the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Pennsylvania’s Goals: Partner with large healthcare systems to improve the quality of care for children by 1) implementing electronic screening questionnaires 2) encouraging improvement on child-focused quality measures 3) improving electronic health record (EHR) functionality

Insights Results

Overview of model

  • Pennsylvania partnered with Children’s Hospital of Philadelphia (CHOP) and Geisinger Health System to implement new electronic screeners into EHRs to improve screening rates (screenings for developmental delays, autism, ADHD, etc.)
  • Between 2011 and 2013, developmental screening rates for children under age 3 at CHOP increased from 6.7% to 48.2%
  • CMS’s Model Children’s EHR Format was introduced into 4 health systems and a federally qualified health center (FQHC) to include patient portals, alerts for immunizations, and fields for tracking social and family history
  • The State provided financial incentives to providers to improve child-focused quality measure reporting and performance (a focus on well-child visits, immunization status, body mass index and preventive dental services)

    Key takeaways/implications

    • Physicians participating in the financial incentives program were more likely than their counterparts to generate internal quality reports and indicate that quality reports were effective
    • Insight: Health systems that involved cross-functional teams in quality measurement and information technology efforts made more improvements than those who relied on vendors or had less integrated teams
    • Challenges: 1) Improving electronic systems was challenging for health systems given competing demands for resources, limited provider time and vendor’s resistance; and 2) Programming EHRs to calculate measures was resource intensive and would have been difficult without financial assistance