CMQCC Meeting Notes

Topic

Notes

Action Items

Topic

Notes

Action Items

Topic

Notes

Action Items

Topic

Notes

Action Items

Topic

Notes

Action Items

Northstar “Expanding Comprehensive Postpartum Care in California”

Open

Critical - link between birth and next step in care

Arlene attended a Fed meeting on evidence for post partum… convened CA Dept of Healthcare Services… AHRQ and NIH were the feds with the evidence review.

Where is the definition of risk? There is a clinician group that will do that - at the CA state level. Clinical experts will join in.

• AllianceChicago and OCHIN could be a resource on risk evaluation.

Discussion re: centering model. Arlene is an expert in it. She will look at learning from Centering that could be further integrated.

Arlene has an extensive evidence table.

Leslie

Next Steps - working with a clinical care workgroup and … meetings will start in July. The Pathway will be operationalized … in health plans. it involves public health outside health plan… discussion with us as outpatient world, connection.

Julia

Our work - minimal project this year. We would like to find more funding to execute a more formal model and look at the outcomes.

• We can help connect CA PCA to encourage health centers to implement this, we have the high risk conditions.

Leslie - there is difficulty in getting clinic data because of data sharing issues. Hospital has no clinic data; cannot get clinic data… how can we collect data to make a difference - to do QI on it.

Julia - PP quality side - last year we added working PQCs in states…. we can help accelerate that work… MMRC data shows x… working on inpatient and outpatient linkage. PQCs are hospital groups focused on inpatient interventions to prevent maternal mortality - CA is also working with march of dimes for low-dose aspirin and outpatient initiatives…

The big five states

Julia - we are working with partners in those states TX and NY… we could do a focus on those five states. They meet monthly.

CMQCC will send slides… as they are now.

Next steps - Implementatoin.

Task 2.1 through 2.3

Review existing guidelines and identifying guidelines that could be reasonably turned into measures. We do not anticipate validated and deployed measures in a few months. Framed for quality improvement rather than value based care etc.

There are 2 established postpartum measures in circulation – HEDIS and Postpartum depression screening (2 versions CDC and NCQA).

Run a measure for a year or two to make sure it runs well and then include in incentives.

Notification of clinic that birth has occurred. Electronic transfer is ideal but not required. Maybe a phone call?

Immediate issues/probably need to be seen earlier within 2 weeks: substance abuse, hypertension, cardiovascular disease.

Create a high risk definition – these patients need follow up prior to the routine 6-week postpartum visit.

CMQCC provides human readable measures. Ray will work on terminology stuff.

Task 2.4Task 2.4 –

Have we identified sites for Task 2.4? – OCHIN has sites in California. RCHC has sites in California.

Satisfied by existing knowledge of the work in California. Opportunity to review measures with Redwood and OCHIN.

No cost extension

In progress as of last week Friday

It was sent to Stanford and Leslie had some questions. NCE has to go through to Stanford Finance.

• Is the SOW still the same? Yes.

• End date? July 31, 2023

• Payment schedule? Invoice when work is done.

SOW

Task 1.4 - Share and discuss the environmental scan at the kickoff. Then this is complete.

Task 2.1, 2.2, 2.3 - CMQCC needs clarification on expectations.

• Per Julia, do we have a good definition already? And if we don't, what does that look like?

• Elliot suggests focusing on the postpartum period

Task 2.4 -

Measures and ideas for next year

Measure Documentation and High Risk Pregnancies - Women's Health Post Partum CDS, GDM, eCQM - Confluence (atlassian.net)

• AllianceChicago has local high-risk definitions

• Would it be helpful to partners (for clinical quality improvement component) to create this plan of care?

• Elliot mentions that pregnancy episode is in most EHRs which includes prenatal and postnatal care. Codes are pregnancy related rather than lifetime.

  • AllianceChicago recently implemented Pregnancy Episode. Epic has implemented pregnancy episode in the pregnancy chart - but problem list may not transfer to patient's overall chart.

• Look at PAMR report or national datasets (PMSS)

Kickoff

• CMQCC can present 5-10 minutes on the importance of the postpartum period and transitions to care.

• Also, share the environmental scan.

• AC can present their high-risk definitions.

•  

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Environmental Scan walkthrough

NACHC Guidelines.docx

Adding links if they exist? Terri isn't sure if others would be able to access the links

Sep 16, 2022

SOW: WHPP CMQCC

Deliverable 1 -

• Task 2.1 - Environmental scan is almost complete.

• Task 2.4 - This would need to be completed after we receive funding for Year 5 and kickoff.

Deliverable 2 -

• Much of this could be resolved in a future meeting.

No deadlines for invoicing. Invoice as the work gets done.

Miko already invoiced but he will retract.

Jun 28, 2022

Admin

• NACHC is waiting for updated W-9, Leslie will speak with Michael

Invoicing - Please send invoices any time - no end date.

SOW https://nachc.atlassian.net/l/c/msfPkGUd

CMQCC role: Expertise and assistance on developing measures.

1. Work for March of Dimes - Use of Aspirin

2. Working with Medi-Cal - establishing metrics for managed care organizations

• Room for pilot projects in postpartum

• C-section measures

• Big driver is Medicaid

Apr 12, 2022

• OCHIN and AllianceChicago are nimble enough to get us some data on the new measures.

• Admin Contract - It is in CMQCC/Stanford’s court

• Redwood is still not on contract - CDC has not approved their addition to the project.

• NCQA has specs for PP Depression screening - but costs $400-500

  • https://www.ncqa.org/wp-content/uploads/2019/02/20190208_08_Perinatal_Depression.pdf

  • Postpartum Depression Screening and Follow-Up - NCQA

• What does CMQCC need to create the measures?

  • First step

    • help from Ray on what code sets they DO use.

    • Help the CHCs document date of delivery

    • Focus on 3

      • diabetes

      • severe HTN

  • Second Step

    • Make them more finished via NCQA measure -

      • if positive.

  •