CHIPRA Quality Demonstration Grant

In recent years there has been growing interest in the development of child health care quality priorities and inclusion of children’s healthcare in national discussions on quality measurement and pay-for-performance. The enactment of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 added emphasis and support to strengthen the quality of care and health outcomes for children. The CHIPRA statute of 2009 appropriated a total of $100 million in funding for the Centers for Medicare & Medicaid Services (CMS) CHIPRA Quality Demonstration grants awarded to 18 states in the nation. Pennsylvania was the recipient of a CHIPRA grant providing an opportunity to establish and evaluate a national quality system for children’s health care which encompasses care provided through Medicaid and the Children’s Health Insurance Program (CHIP).

Information on the twenty states chosen as CHIPRA Quality Demonstration grantees can be found at http://www.ahrq.gov/chipra/demoeval/.

Background/Summary of Pennsylvania’s CHIPRA Quality Demonstration Grant

Pennsylvania’s Department of Human Services (DHS) has been awarded a Centers for Medicare and Medicaid Services (CMS) Children’s Health Insurance Program reauthorization Act (CHIPRA) Quality Demonstration Grant also known as QUICKSTEPS (QUality Improvement and Care for KidS Through Electronic ProgramS). The five year CHIPRA QUICKSTEPS grant runs from February 22, 2010 through February 21, 2015. The total amount of funding awarded to PA DHS is $9,794,571.

For the grant, DHS is partnering with the Pennsylvania Insurance Department (PID) that oversees the state’s Children’s Health Insurance Plan (CHIP) and the PA Department of Health that oversees the PA State Immunization Information System (PA-SIIS). DHS is also partnering with seven health systems which give a varied snapshot of care across the state. Those partners are: Geisinger Health System, Children’s Hospital of Philadelphia, St. Christopher’s Hospital for Children, Children’s Hospital of Pittsburgh of UPMC, Hamilton Health Center, Penn State Hershey Medical Center and Pocono Medical Center.

Pennsylvania’s CHIPRA grant focuses on three areas distinguished by category letter.

Category A—Testing and reporting on the pediatric core measures of quality. The objective is for the seven health systems and their pediatric provider practices to focus on improving the quality of care through the adoption of health information technology by electronically extracting and reporting from their electronic health records (EHRs) the CMS core pediatric quality set which identifies twenty-four pediatric specific quality measures. Also under category A, the seven health systems will achieve bi-directional linkage with PA-SIIS which will allow for the electronic exchange of immunization data between the health systems and the PA DOH. For more information see the CHIPRA Grant Quality Information page.

Category B— Promoting the use of HIT in children’s healthcare delivery. The objective is to leverage HIT to maximize the early identification of children with developmental delay, behavioral health issues and those with complex medical conditions so their care can be closely coordinated with the PCP medical home, appropriate medical specialists and child serving social agencies. A pre-clinic visit screening tool to enhance provider and patient communication and an electronic referral/care plan tracking system that links children with special needs to appropriate services will be implemented at all seven health systems. In addition to the screening tool, two projects focusing on children with hypertension and transitioning children from hospital to home will also be created. For more information see the CHIPRA Grant Quality Information page.

Category D— Demonstrating the impact of the CMS model pediatric electronic health record. The objective is to implement the CMS/AHRQ (Agency for Healthcare Research and Quality) pediatric electronic healthcare record (PEHR) model format template at the five health systems participating in category D. The model format is not an actual EHR; it is a model which signifies what the optimum pediatric EHR would be if all recommended elements were implemented into an existing EHR. The model format consists of twenty-one topic sets covering areas such as medication management, prenatal screening, growth data, etc. The twenty-one topic sets are comprised of 568 requirements which further define clinical application of the topic sets. The CHIPRA grantees will decide which model format requirements are implemented at their health system. The varied application of formats across a variety of health systems, from academic hospitals to Federally Qualified Health Centers (FQHC), will offer a robust picture of the challenges and successes that await the nation as electronic health records become the standard. For more information see the CHIPRA Grant Quality Information page.

CHIPRA Presentations

These presentations offer a chronologic view of the progression of grant activities. Click on the links to view the presentations.

2011

CMS Quality Conference 

Pennsylvania Chapter of the American Association of Pediatrics 

Medical Assistance Advisory Committee

2012

Pennsylvania Chapter of the American Association of Pediatrics 

2015

2015 CHIPRA Summit

CHIPRA Communications and Updates

Throughout the year various CHIPRA updates are provided to external stakeholders and to DHS senior management. Below you will find links to these documents.

Updates

2015 CHIPRA Summit

Introducing Electronic Screening Tools for Developmental Delay and Autism into Pediatric Primary Care

CMS CHIPRA Quality Conference

CHIPRA Grant Quality Information

The goal of this funding opportunity is to establish and evaluate a national quality system for children’s health care. The CHIPRA grant provides Pennsylvania with a foundation for the development of a child based quality improvement framework. Grant activities will provide ongoing information to estimate the overall quality of health care for Pennsylvania’s children, to analyze data with regard to disparities, usage of preventive services, services for acute conditions, and the continuity of care strategies for children with chronic conditions.

Category A - Testing and reporting on the pediatric core measures of quality

CMS Core Pediatric Quality Measures

How the measures are collected

2010 and 2011 Aggregate Quality Rates

Category B - Promoting the use of HIT in children’s healthcare delivery

Overview of the pre-clinic visit screening tool

Category D - Demonstrate the Impact of the Model Pediatric Electronic Health Record Format

Overview of the model format project

CHIPRA in Support of Meaningful Use 

Other Topics

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

Using the Core Set of Quality Measures

How are CHIPRA Quality Demonstration States testing the Children’s Electronic Health Record Format?

CHIPRA 10-State Evaluation

CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings

CHIPRA Contact Information

If you have any questions and/or feedback about the Pennsylvania CHIPRA Quality Demonstration Grant, we recommend you contact us through:

Email: You may email us at: CHIPRA@pa.gov

Contact Other States

For information on the twenty states across the nation that have received CHIPRA Quality Demonstration Grants, please visit:

Website: http://www.ahrq.gov/chipra/demoeval/