Summary
- Promising data practices can drive better health care for children, as well as full reimbursement for the vital work of clinics.
One of the biggest barriers in the health care safety net is ensuring that children receive their well-child visits and related screenings so providers can help them get off to a healthy start in life. Closely tied to that barrier is another major hurdle: data. Clinics must collect and analyze data to see how close they are to their goals — something that’s crucial for both providers and patients. Data analysis, in fact, can often uncover issues that are preventing clinics from being fully reimbursed by health plans.
Driving Better Care and Full Reimbursement
Phase One of the Child Health Equity Collaborative, a 13-month program run by the Institute for Healthcare Improvement (IHI) and funded by California’s Department of Health Care Services, has made “Equity & Transparent, Stratified, and Actionable Data” one of its key interventions for managed care plans throughout the state. Over the last 10 years, California has given Medi-Cal managed care plans more responsibility, funding, and accountability to drive outcomes toward health equity, but health plans have often lacked the training and support they need to do so.
Phase One of the Child Health Equity Collaborative, for which Center for Care Innovations (CCI) is an implementation partner, takes a key step toward meeting that need. All Medi-Cal managed care plans are participating in the program, which is slated to finish by mid-2025. The goal of the program is to improve the completion of well-child visits in infants (0-30 months) and adolescents (15-18 years) through five different interventions with tools, guidance, and coaching.
Here are three promising practices — or “bright spots” — explored by Alameda Alliance for Health, a local, public, not-for-profit managed care health plan committed to making high-quality health care services accessible and affordable to Alameda County residents. These new practices can help clinics expand well-child visits and seek full reimbursement for them, while better meeting patients’ needs for quality care. They can also help health plans in their reporting to the Department of Health Care Services on quality improvement, including improving health outcomes, reducing hospital readmissions, and ensuring patient safety.
Promising Practice #1: Data Stratification
For James Burke, Alameda Alliance for Health’s lead quality improvement project specialist, the program’s most exciting intervention involved actionable data.
“That was the fun part for me because I’m a data nerd,” Burke said. “We even learned about new tools we have at the Alliance that we didn’t know about, like the social determinants of health dashboard.”
The data was limited to a select number of providers who provided Z codes (used to document social determinants of health, or SDOH, data) and is hard to filter. Still, the team members were able to successfully stratify well-child visit rate data by age, ethnicity, and ethnicity plus age. This granular data, in turn, made it possible for Alameda Alliance to identify gaps and areas to target or expand. For example, Alameda Alliance was able to document the soaring rates of “W15s,” or well-child visits that assess children from newborn to 15 months old, among its clinics.
While data insights have been critical to informing strategies, implementing those strategies on the ground has brought its own set of challenges. Burke said it’s been extremely challenging to meet the deadlines of the Child Health Equity Collaborative. “Both our providers are just so busy — it’s hard to keep up with the fast-moving timelines. But once we do connect with the clinics, it’s very engaging.”
Quality improvement (QI) project specialist Fiona Quan agrees. She said Alameda Alliance’s monthly meetings with providers have gone well, and the clinics have been “very receptive” to the interventions.
Through his data research and talks with different providers, Burke has found that some clinics “don't bill for the full package” for the well-child visit, sometimes neglecting to bill for lead screening test that is part of that visit — an omission that essentially leaves money on the table.
“When you're thinking of the younger age [patients],” he said, “it’s not just the well visit that you have to bill for, you have to do the developmental screening and the lead screening, and everything has a different code.” With more education on data and billing, he said, clinics’ bottom line can be healthier.
Alameda Alliance met the W15 benchmark recently for the first time in many years, something Burke attributes to better data. “It’s really exciting to see,” said Burke. “We did so much education. Now it’s a matter of fine tooth-combing where those issues are and kind of digging in a little bit deeper to help other clinics — or maybe center our attention to where there’s some really big hotspots.”
Promising Practice #2: Training Webinars and Continuing Education
Alameda Alliance hosts webinars about quality improvement for health care employees. These are open discussions for providers to surface the obstacles and barriers they face, raise questions about challenging measures, and share best practices. Not surprisingly, they’re very popular.
In addition, Alameda Alliance offers continuing education credits to nurses. They are working to expand the offering to all clinicians who are interested.
“What’s more enticing for clinics is education units for nurses, medical assistants, MDs and so forth,” said Burke. “So, we want to put that on the table.”
Promising Practice #3: Interviews with Providers, Patients, and Caregivers
Alameda Alliance helps clinics interview providers, patients, and caregivers to further investigate clinic needs and gaps in care.
The findings revealed several unmet basic needs among safety net patients that the clinics pledged to address. One key issue was that the transportation benefit, which was not working effectively. Patients reported difficulties scheduling rides, and in some cases, transportation never arrived, preventing them from reaching the clinics.
The clinics also learned that vendors didn’t always have vaccinations in stock, there were not enough providers to meet the needs of patients, and there was a disconnect between primary care doctors and referrals to dentists, behavioral health, or Individualized Education Programs (IEP) school programs. There was also a short supply of non-medical specialists, such as nutritionists.
Clinic leaders then brainstormed ways to overcome these obstacles, such as linking patients to the Alameda County Office of Dental Health, having the clinic staff arrange rides for patients, and connecting patients to behavioral health programs.
Another round of interviews found some patients waited for an hour to see providers or left messages with no return calls. This yielded recommendations for better case management, community resources, and an Alameda Alliance work-flow study.
Continuing the Work
Alameda Alliance continues to work with its clinic sites using strategies based on the interview learnings. By identifying and working to eliminate gaps in care, health care organizations can reduce costs, achieve better quality scores, boost individual health outcomes, and better improve the patient journey. A key benefit of the Child Health Equity Collaborative is helping health plans better support hard-working safety net clinic providers, Burke said. “If we understand their [quality improvement] practices a little better, we can truly reflect what they’re doing and their work.”
Briana Harris is program manager at CCI. Nickita Gupta is senior program coordinator at CCI.
This piece was also published on the Center for Care Innovations’ Resource Center.
Photo by Chayene Rafaela on Unsplash.
You may also be interested in: