Health Care Reform & Title V Leadership
VT has a long history of leadership in health care reform policy designed to reach the goal of universal health insurance coverage & increasing access to quality & affordable health care. Ongoing federal & state healthcare reform activities & changes continue to impact pediatric care, including CSHCN. MCH works very closely with the prevention-focused Blueprint for Health & Women’s Health Initiative, supporting planning & implementation of VT’s 1115 Medicaid waiver.
VCHIP, with funding & support from MCH, completes a yearlong QI project with providers throughout Vermont. Multiple State fiscal years (FY) overlap normal Title V reporting periods. The FY20 QI topic was “Sharpening our Focus on ADHD: Using Guidelines & Partnerships to Improve Outcomes.” The fall Learning Session & subsequent collaborative effort focused on assessing for co-occurring mental disorders associated with ADHD, such as emotional or behavioral conditions including suicidal ideation. The aim was to improve knowledge & skills for the evaluation & treatment of ADHD in children & adolescents, & to assure documentation of impairment in more than one setting. The current topic was “Strengthening Vermont’s system of high-performing pediatric medical homes.” Components of the project anticipated to be included are: (1) Screening & follow-up for recommended preventive services (blood lead testing, vision screening, hearing screening, oral health, Social Determinants of Health; & Developmental Screening). (2) Maximizing the use of practice-based care coordination resources. (3) Aligning practices with health reform payment incentives. The FY22 project will be a second year of this topic. Some expected changes to this year’s project include: (1) incorporating additional measures: parental depression & social emotional screening & follow-up; (2) Maximizing the use of practice-based care coordination resources; (3) Racial & Health Equity; & (4) Aligning practices with health reform payment incentives. Next year’s year-long QI project is focused on adolescent and youth mental health and dovetails beautifully with Vermont’s HRSA-funded Pediatric Mental Health Care Access grant.
Perinatal Quality Collaborative
The Perinatal Quality Collaborative—Vermont (PQC-VT) is a relatively new collaborative structure. Although Vermont has a long and successful history of implementing quality projects in obstetrical, neonatal, and pediatric care through partnership between the Vermont Department of Health (VDH) MCH Division and VCHIP, the PQC-VT is a relatively new structure. Vermont has made significant improvements in the care of pregnant Vermonters, newborns and infants through initiatives like the OB-Outreach, Alliance for Innovation on Maternal Health (AIM), Vermont Regional Perinatal Health Project, and Improving Care for Opioid-Exposed Newborns. However, Vermont lacks a collaborative structure able to knit together systems (health care and community services) across the perinatal period and into early childhood. This CDC opportunity will provide the newly formed PQC-VT with the infrastructure to create this continuum of support.
In October of 2020, all VCHIP’s pregnancy, newborn and infant initiatives were unified under the PQC-VT in partnership with MCH. The mission of the PQC-VT is to optimize care and health outcomes in pregnancy and infancy through collaboration and continuous QI. The PQC-VT improves care and health outcomes of Vermont’s pregnant people, newborns and their families by:
- Setting Perinatal Outcome Priorities: Actively engage perinatal health care professionals, MCH public health experts and community-based partners in developing a common agenda by highlighting current successes and gaps in perinatal care and identifying focusses for pregnancy and infant health outcomes.
- Providing Outreach and Education: Build relationships across sectors including hospitals, outpatient practices, community-based organizations, state health programs, and families to address perinatal issues, and provide opportunities for collaborative learning on best practices.
- Advancing QI Efforts: Mobilize perinatal health care teams in continuous QI efforts for improved health outcomes, and disseminate successful system approaches. Develop quality metrics appropriate for perinatal health care.
- Monitoring Health Care Outcomes: Analyze perinatal and public health datasets to gauge QI work and opportunity, evaluate program implementation, and perform health outcomes surveillance.
The PQC-VT, has organized and unified VCHIP’s pregnancy, newborn and infant initiatives to coordinate QI efforts, education and outreach activities, and perinatal priorities. Through these initial efforts, it is clear the PQC-VT needs outreach coordination, additional data analytics support, and community birthing hospital expertise in perinatal QI. In the coming year(s), Vermont plans to cement the PQC-VT organization and move it from concept to action.
Other Health Systems Innovations
As the COVID-19 pandemic was emerging, MCH leveraged our existing partnership with VCHIP as one means of assuring timely dissemination of credible, accurate information. Beginning March 18, 2020, calls were conducted 4 days/week. The initial target audience consisted of pediatric & family medicine practices throughout the state. Content included streamlined & pediatric-focused clinical guidance, virtual sharing of strategies (e.g., how to triage provide testing & clinical care, including via telehealth), & a Q&A. The target audience quickly expanded to include a broad array of community partners, including school nurses and child- & youth-serving organizations. As of June 2022, calls are conducted once a week, with plans to reevaluate as we approach the fall & school reopening. Throughout, we have continuously adjusted this process in response to participant feedback.
There have been over 240 calls as of June of 2022. This unique connection to the provider community was instrumental in gathering feedback & garnering support for public health policy, guidance, the creation of tools & resources, & connecting providers to support efforts in their community during the ever-evolving pandemic (& the evolving evidence-base, knowledge/resources available for COVID-19).
MCH continues to provide infrastructure & convening support to school-based health centers who wish to learn from each other & collaborate. We have begun to assess SBHC status & identify current & new contacts since the pandemic put much of this working together on hold. School Liaisons update an inventory of SBHC & provider relationships with schools & support local efforts to form SBHCs. MCH does much of this work through VT’s SBHC Peer Collaborative, a way to share information, problem solve, network, & support effort. MCH has reached out to the School Based Health Alliance to gather feedback & support from national SBHC experts. This work was put on hold since the beginning of the pandemic, but we are looking forward to renewed efforts this year. MCH will also partner with the Youth Health Improvement Initiative at VCHIP to develop an assessment tool for existing SBHCs, identify common assessment measures, consider training & development opportunities. YHII will be surveying our SBHC peer collaborative members, & will share findings with MCH & stakeholders. This work is ongoing due to difficulties with response rates while our school/provider partners are still heavily engaged with pandemic related activities.
MCH Coordinators & School Liaisons promote Bright Futures EPSDT periodicity schedule, topic specific initiatives ie: promoting annual well-child visits or universal developmental screening with health care providers & community partners (including schools). Promotion includes verbal communications, written resources, website updates, support for regional community meetings, etc. The COVID-19 pandemic has demonstrated the importance of these relationships & community connections. We aim to maintain this level of provider engagement and build upon improved coordination & communication with health care providers & health care systems delivery & community stakeholders
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