GPRA National Medicaid Childhood Immunization Improvement Initiative

1
GPRA National Medicaid Childhood Immunization
Improvement Initiative

• Presentation by Rachel Block,
• Center for Medicaid and State Operations
• Institute of Medicine Workshop on Strategic
  Vision for Financing the US Immunization System

2
Overview of Presentation

• Brief Background on GPRA
• Description of Process and Status of Medicaid
  Childhood Immunization Improvement Initiative
• Relationship to Other Initiatives - CASA/AFIX,
  immunization registries, HEDIS
• Lessons Learned I Issues in Performance
  Measurement
• Lessons Learned II Federal Interagency
  Coordination
• Conclusion

3
What is GPRA?

• Government Performance Results Act of
• All Federal agencies must develop performance
  goals that demonstrate improved outcomes and
  report to OMB and Congress on progress toward
  goals
• Medicaid childhood immunization rates selected as
  the first clinical/utilization related
  performance measure
• Other Medicaid measures include enrollment of
  eligible children and dual eligibles

4
Process for Implementing GPRA Project

• Topic agreed to by leadership of HCFA and
  National Association of State Medicaid Directors
• States would be invited to participate in phases
  or groups over a three-year period
• Broad parameters - measure and improve
  immunization for Medicaid two year olds to
  achieve HP 2010 goal
• States decide exact specifications - age,
  immunization measure, improvement goals

5
Process (contd)

• Each State develops baseline measurement and
  tracks improvement for three years
• CDC full partner from the beginning assist
  States in development of measures and improvement
  strategies, coordinate VFC and Medicaid resources
  at the state level

6
Relationship to other initiatives

• CASA/AFIX targets improved record keeping and
  performance at the provider level
• Immunization registries support data collection
  at the State level
• HEDIS used by many states to measure health plan
  performance
• National immunization survey another source of
  baseline data

7
Lessons Learned Performance Measurement

• High level of complexity due to
• immunization schedule
• lack of continuous enrollment
• different financing/delivery system arrangements
  within a state
• HEDIS and NIS measure differently
• CASA/AFIX doesnt capture full universe of
  providers

8
How Many Two-Year Olds Are Left
Percent of Two-Year Olds Enrolled for
Data from HCFA - sponsored survey April - May 2001
9
Lessons learned (contd)

• GPRA project will result in much improved
  measurement as a result of this experience!

10
Lessons Learned Federal Interagency Coordination

• Setting the example for State level coordination
  between Medicaid and health agencies
• Leveraging programs and dollars
• Convergence and reinforcement of standards for
  systems and performance measurement

11
Conclusion

• We can achieve common areas of performance
  measurement if we give states some flexibility in
  the methodology
• Performance measurement is difficult
• What started as focus on performance measurement
  has turned into focus on quality improvement
• Fed agencies need to provide leadership to
  identify and (actively) facilitate convergence of
  Medicaid and public health interests