Vol. 1, No. 4
November 2001

Contents

A Word from the Editors

Working with Medicaid Plans to Build Best Clinical and Administrative Practices

Reaching Our Children: A Compendium of Outreach Models

Models That Work Winner

Clinics Opening at Cub Stores

ROInfo™

About M. Davis and Company

A Word from the Editors

Public program administrators and managed care executives are increasingly being called upon to demonstrate the efficiency and effectiveness of their program/organization. For programs such as Medicaid and SCHIP, two measurement indicators are: (1) percent of children receiving age appropriate immunizations and (2) access to primary health care services.

In order to make certain their organizations are "on track" to meet these and other critical performance indicators, executives are required to make significant decisions in a timely manner, using the best market information available. Decision makers must have high returns on the market information provided. M. Davis and Company, Inc., provides public program administrators and managed care executives a product - high return on information (ROInfo™) - that most effectively identifies challenges facing their organizations and best solutions to those challenges.

ROInfo™ through the use of a range of research methods and techniques, program designs and monitoring tools, provides clients with critical information in real time. This timely presentation of critical performance information, improves executive decision making and organizational performance.

We hope to use this newsletter to highlight for public program administrators and managed care executives some of the current research, key findings, initiatives and best practices in the industry. We welcome your comments.

Medicaid and State Health Insurance Program plans across the country share common goals and obstacles in providing quality, cost-efficient services for their enrollees. To respond to the challenges faced by these plans, the Center for Health Strategies (CHCS) created the Best Clinical and Administrative Practices (BCAP) program to enhance quality care to enrollees. "Most Medicaid plans are involved in quality improvement activities but their knowledge of what is going on elsewhere may not extend beyond their own markets," says Richard Baron, MD, Senior Medical Consultant to CHCS. "Through BCAP we're working with health plan leadership to gather, refine and disseminate plans' collective experience."

Health plans participating in the BCAP program are using a four-step model, focusing on OUTREACH, to develop comprehensive best practices around a defined topic (e.g., pediatric preventive care, birth outcomes, asthma care). Plan workgroups, including teams of Medical directors and other key decision makers from participating plans are organized around a specific topic.

The Improving Preventive Care Services for Children workgroup began meeting this month. Participating plans created these goals for their pilot programs.

• Aloha Care of Hawaii: Increase the provision of preventive services for children to 100 percent by age 18 months.
  
  
• Americaid Community Care of Illinois: Increase HEDIS scores for well-child visits by 10 percent between 2000 and 2001.
  
  
• AmeriChoice of Pennsylvania: Increase the percentage of childhood immunizations from 56 to 75 percent.
  
  
• Blue Cross of California: Increase the number of children less than two years of age meeting immunization and well-infant schedules.
  
  
• Community Health Network of Connecticut: Increase EPSDT visits in adolescents by 60 percent.
  
  
• Neighborhood Health Plan of Massachusetts: Improve HEDIS immunization scores for two-year-olds from 76 to 93 percent by 2002.
  
  
• Neighborhood Health Plan of Rhode Island: Improve adolescent preventive service access through partnership with school-based health centers.
  
  
• The Wellness Plan of Michigan: Improve immunization rates from 72 to 80 percent for children under age two.

Link to article: www.chcs.org/publications/pdf/mcbps/CHCSIssue.pdf

Millions of children face multiple barriers in accessing health care services. There are presently over 10 million uninsured children in the United States; over 4 million of these children are eligible for either Medicaid or State Child Health Insurance Programs (SCHIP) but not enrolled. Reaching out to these children has become a national priority.

Effective outreach programs provide a complement of enabling services in order to reach children in their communities, enroll them in programs for which they are eligible, and increase their access to preventive care. These programs use many techniques, such as peer outreach, multimedia campaigns, health fairs, patient transportation services, coalitions of service providers, and service provision at convenient locations in the community. They play an important role in identifying children who are eligible for either SCHIP or Medicaid and enrolling them into these programs. States can incorporate elements of these projects and use of community workers into SCHIP outreach activities. In addition, projects can help assure that children get the health care services they need once they are enrolled in an insurance program. Successful outreach models include:

• Project Vida (El Paso, Texas): The project provides health care services, housing assistance, educational programs and after school activities at one community center; the program at the same center provides Medicaid application assistance. Success: 97 percent of children and infants registered with the program are up to date with their immunizations.
  

Models That Work Winner
Multiplying Community Solutions, Overcoming Barriers, and Scoring Economic Dividends

Nurse-Managed Community Health Center
Abbottsford and Schuylkill Falls Community Health Centers
Resources for Human Development
Philadelphia, Pennsylvania

• Precedent-setting nurse-run entity for managed care contracts and Medicaid reimbursement
  
  
• Gives oversight role to, and creates jobs for, housing development residents
  
  
• Has provided primary care to over 2,400 of 4,200 residents since starting in 1992
  
  
• Cut the rate of underweight newborns from 13.6 percent to less that 2 percent
  
  
• Cut ER usage from excessive, inappropriate levels to below-average levels
  
  
• Increased immunization rates while helping to decrease morbidities

The Abbottsford Community Health Center and the Schuylkill Falls Community Health Center are nurse-managed primary health care centers serving two public housing communities by addressing many underlying health and social problems. Services are provided by nurse practitioners, three of whom hold joint appointments at the University of Pennsylvania Graduate School of Nursing, Family Practice Division. Physicians are available for phone consultation and visit the Centers monthly.

The Centers provide primary care, prenatal care via a nursing/outreach team (including a nurse midwife), community nurse home visits, health education particularly in diabetes and asthma, smoking cessation, parenting support and education, violence prevention, support for grandparents raising grandchildren, mental health services and drug and alcohol treatment. Alanon, Overeaters Anonymous, and Alcoholics Anonymous programs are located on-site. Transportation is provided to specialists, dentists and the health centers when necessary.

The Centers have reduced ER use, hospital days and had only one low birthweight baby out of the 70 women to whom they have provided prenatal care. The model has been reproduced in two underserved areas of Philadelphia and are currently managed by schools of nursing. As a result of the activist role taken by the nurses, state regulations have been adjusted regarding the ability of nurse centers to contract with HMOs as primary care providers.

Link to full article: www.bphc.hrsa.gov/mtw/Mtww1.htm

Clinics Opening at Cub Stores
QuickMedx plans nine more clinics by 2001

by Shannon Hahn

Cub Foods has gotten into the business of providing health care - sort of. It's invited an Edina-based startup to operate nurse-practitioner clinics in some of its Twin Cities stores.

QuickMedx aims to provide consumers with a quick, convenient and cost-effective alternative to some urgent care and clinical services.

It's now in three Cub stores and intends to open up to nine more by January.

"This is a way for busy families that don't want to stand in line and make appointments in doctors' offices to get every-day health issues taken care of in a place that they are in fairly often," said Rita Simmer, a spokeswoman for Eden Prairie-based Supervalu Inc., which owns Cub Food Stores.

QuickMedx is targeting patients who seek rapid testing, diagnosis and prescriptions for common illnesses.

You can view this article on the web at:
http://twincities.bcentral.com/twincities/stories/2000/11/06/story7.html

ROInfo™

Today's environment requires both public and private sector executives to make significant decisions in a timely manner, using the best market research information available. Decision makers must have high returns on the information provided. It is our aim at M. Davis and Company, Inc., to provide program managers, policy analysts and managed care executives a product - high return on information (ROInfo™) - that most effectively identifies challenges facing their organizations and best solutions to those challenges.

ROInfo™ through the use of a range of research methods and techniques, program designs and monitoring tools, provides clients with critical information in real time. This timely presentation of critical performance information, improves executive decision making and organizational performance.

ABOUT M. DAVIS AND COMPANY

M. Davis and Company, Inc., is a market research and consulting firm that provides complete services from project conception through implementation. We aim to ensure that our clients receive a high return on information (ROInfo™) by employing our unique perspective and market insights. We help clients make the most of their opportunities and implement solutions based on the information we provide. Our clients include federal and state agencies as well as private sector companies from healthcare, retail and transportation industries. Projects have included:

• Immunization Campaign Effectiveness. M. Davis and Company, on behalf of the U.S. Department of Health and Human Services - Centers for Disease Control, conducted a multi-wave national telephone survey to assess the level of awareness and impact of the national immunization advertising campaign.
  
  
• Health Risk Assessments. M. Davis and Company - on behalf of a multi-state managed care organization serving SCHIP, Medicaid and Medicare members - developed and administered a customized health status survey. Over 50,000 assessments have been completed by telephone interviews.
  
  
• Enrollee Satisfaction Surveys. M. Davis and Company has designed and administered over one dozen managed care enrollee satisfaction surveys for six organizations, whose memberships ranged from 30,000 to 100,000 covered lives. These surveys have included SCHIP, Medicaid and Medicare enrollees.

We are pleased to announce that M. Davis and Company, Inc. was recently selected by the U.S. Department of Transportation to administer the Omnibus Household Survey. This multi-year engagement involves the monthly administration of over 1,000 telephone surveys to randomly selected households to gather information regarding commuting habits and awareness of various Federal safety initiatives.

We believe our clients are buying solutions, not volumes of data. To achieve success, our clients need "added value" and we supply it. We forge a close relationship with our clients, becoming their trusted partner, instead of a supplier. With better understanding of our clients, we narrow the gap between their objectives and operations by providing information tailored to their needs and designed to help them achieve: "high margin" information. Our clients can then employ strategies and tactics that produce success.

For more information on our capabilities, please visit our web site: www.mdavisco.com.
To speak directly with one of our consultants, please call 215-790-8900.

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