Meeting 8

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October 2, 2019

Raising a Hand via Webinar

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Agenda

  1. Welcome and Agenda                                                             5 min
  2. Co–Chair Welcome                                                                  15 min
  3. DOH Welcome & Update on Project Implementation       30 min
  4. Discussion                                                                                 30 min
  5. First 1000 Days in Context                                                       5 min
  6. Closing & Next Steps                                                                 5 min
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Co–Chair Welcome

Nancy L. Zimpher, PhD
Professor, University at Albany

Beth Berlin
Acting Commissioner, NY State Education Department

DOH Welcome

Donna Frescatore
Medicaid Director and Executive Director, NY State of Health

First 1,000 Days on Medicaid: DOH Leaders

  • Donna Frescatore, Medicaid Director and Executive Director, NY State of Health
  • Liz Misa, Deputy Medicaid Director
  • Dr. Douglas Fish, Medical Director, NY State Department of Health
  • Dr. Stephen Cook, Medical Director, NY State Department of Health
  • Dr. Khalil Alshaer, Medical Director, NY State Department of Health
  • Kathryn Russell, Medicaid Program Manager, NY State Department of Health
  • Kimberly Jones, Project Manager, NY State Department of Health
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DOH Update on Project Implementation

Douglas G.Fish, MD
Medical Director, Division of Medical & Dental Directors (DMDD)
Office of Health Insurance Programs

Kathryn Russell
Medicaid Program Manager
Office of Health Insurance Programs

Steve Cook,MD,MPH
Medical Director, DMDD
Office of Health Insurance Programs

Khalil Alshaer, MD,MPH
Medical Director, DMDD
Office of Health Insurance Programs

First 1,000 Days on Medicaid: 10–Point Plan

Final Rank Recommendation Description
1 Recommendation 17: Braided Funding for Early Childhood Mental Health Consultations
2 Recommendation 10: Statewide Home Visiting
3 Recommendation 1: Create a Preventive Pediatric Clinical Advisory Group
4 Recommendation 4: Expand Centering Pregnancy
5 Recommendation 2: Promote Early Literacy through Local Strategies
6 Recommendation 14: Require Managed Care Plans to have a Kids Quality Agenda
7 Recommendation 5: New York State Developmental Inventory Upon Kindergarten Entry
8 Recommendation 20: Pilot and Evaluate Peer Family Navigators in Multiple Settings
9 Recommendation 18: Parent/Caregiver Diagnosis as Eligibility Criteria for Dyadic Therapy
10 Recommendation 16: Data System Development for Cross-Sector Referrals

Status Updates

#2 Early Literacy through Local Strategies–to improve early language development by expanding "Reach Out and Read" in pediatric primary care.

  • Developing evaluation strategy, narrowing down regions to launch pilot, working with

ROR for pilot strategy implementation.

# 5 Developmental Inventory upon Kindergarten Entry–to create standard measurement tool(s) for use at that milestone.

  • SED scheduled stakeholder committee workgroup meeting to discuss assessment tool menu.

#10 Statewide Home Visiting–NYS Medicaid to take significant steps to ensure the sustainability of home visiting in NY, so every child and pregnant women who is eligible and desiring of services, receives them.

  • Received recommendations from the workgroup, with top two recommendations being Central Intake and Universal Light Touch. Working internally to strategize pilot roll–out.

#16 Data System Development for Cross–sector Referrals–to develop a screening and referral data system that connects families to nearby health and social services.

  • Working with NYS Office of Quality and Patient Safety (OQPS) to explore possible avenues to build on infrastructure of qualified entities.

#20 Peer Family Navigators in Multiple Settings–to launch pilot projects to help hard–to–reach families connect to resources.

  • Developed landscape of existing Peer Family Navigators/ Community Health Workers efforts and what´s currently supported. Based on findings, looking to potentially pilot in clinical settings

#1 Create a Preventive Pediatric Care Clinical Advisory Group

This recommendation is to convene a clinical advisory group charged with developing a framework for how best to organize well–child visits/pediatric care in order to implement the Bright Futures Guidelines (the American Academy of Pediatrics standard of care).

  • DOH Office of Health Insurance Program (OHIP) Lead: Dr. Douglas Fish
  • Partners: Office of Quality & Patient Safety, Office of Public Health–Division of Family Health
  • The Clinical advisory group, chaired by Dr. Mary McCord of Gouverneur Health and Dr. Dennis Kuo of University of Buffalo, convened 5 times in 2018
  • Report submitted to and accepted by the New York State Department of Health
  • Emphasizes 2–Generational care
  • Supports an integrated system of child health, building on the traditional patient–centered medical home model
  • higher standards for comprehensive well–child care that call for the integration of evidence–based interventions to support optimal growth and development;
  • care coordination/case management capacity for navigating across medical services and social determinants of health; and
  • integrated behavioral health care that is sensitive to the relationship between the health care practitioner and family.

Preventive Pediatric Care Clinical Advisory Group´s Recommendations

  1. Embrace the NYS Model of Pediatric Population Health
  2. Continue to invest in the core programs that comprise the NYS Model of Pediatric Population Health and fill funding gaps.
  3. Pilot the NYS Model of Pediatric Population Health with the goal of defining an alternative payment model that supports this population health–based model of primary care for children.
  4. Interpret primary care patient–centered medical home (PCMH) standards for pediatrics, and advance health and education collaborations to improve the baseline performance for all NYS pediatric practices.
  5. Track progress toward implementing the NYS Model of Pediatric Population Health and its impact on children´s health, development, and well–being.

    A copy of the Clinical Advisory Group´s full report is available here.

#4 Expand Centering Pregnancy

This recommendation is for Medicaid to support a pilot project in the neighborhoods/communities of poorest birth outcomes to encourage obstetrical providers serving Medicaid patients to adopt the Centering Pregnancy group–based model of prenatal care

  • DOH OHIP Lead: Dr. Khalil Alshaer
  • Partners: DOH Office of Quality & Patient Safety, Island Peer Review Organization (IPRO), Centering Healthcare Institute (CHI)
  • Pilot sites were identified through collaboration with CHI and Medicaid managed care plans interested in the pilot. Phase 1 of pilot, existing sites, launched in June 2019
  • Pilot focuses on 2 key measures: low birth weight and rates of preterm birth, in addition to other maternal health outcome measures that might be impacted by the Centering Pregnancy model.
  • Phase two, new sites, expected to launch in Fall/ Winter 2019.

#14 Require Managed Care Plans to have a Kids Quality Agenda

Under this recommendation, the Department of Health would develop a two–year effort (Performance Improvement Project) working with managed care plans to improve child health and perinatal health measures.

  • DOH OHIP Lead: Dr. Khalil Alshaer; Co–Lead: Dr. Jeanne Alicandro
  • Partners: DOH Office of Quality & Patient Safety, Island Peer Review Organization (IPRO)
  • Pilot launched early this year as a Performance Improvement Project involving all Medicaid managed care health plans, with three main focus areas:
    1. Blood Lead Testing and Follow–up;
    2. Newborn Hearing Screening and Follow–up;
    3. Developmental Screening

#17 Braided Funding for Early Childhood Mental Health Consultations

This is a recommendation for the Office of Health Insurance Programs to convene a cross– agency design committee to explore a braided funding approach for paying for mental health consultation services to early childhood professionals in early care and education settings.

  • DOH OHIP Lead: Jonathan Lang
  • Partners: NYC DOHMH, NYS OMH, OASAS, OCFS, OPWDD, SED, CCF
  • State–led workgroup met five times from Jan–Aug 2019
  • Convened a non–state led committee
  • Completed an analysis of each agency´s current Early Childhood Mental Health Consultations (ECMHC) programs and policies
  • Identified gaps in current service provision and opportunities for interagency collaboration to improve the current state of ECMHC by leveraging existing resources;
  • Determined what additional resources would be required to implement ECMHC in NY
  • Developed recommendations on how to best use existing resources and develop new resources

#18 Parent/Caregiver Diagnosis as Eligibility Criteria for Dyadic Therapy

This recommendation is to allow children´s Medicaid enrollment to cover a proven parent/child therapy model based solely on a parent´s mood, anxiety, or substance use disorder diagnosis.

  • DOH OHIP Lead: Emily Steinbach
  • Partners: OASAS, OMH
  • Finalized research on Dyadic Therapy statewide and other state approaches
  • Engaged with CMS to discuss precedent for billing under baby´s Client Identification Number (CIN)
  • Medicaid Update in review; anticipated Fall 2019 Medicaid Update release

Additional Initiative Activities

  • OHIP and OQPS evaluation plan
  • Albany Connections´ pilot
  • Collective Impact Training in parallel to First 1000 Days (pilot regions/ communities)
  • Maternal health initiatives: Support statewide efforts of Office of Public Health to reduce maternal mortality and racial disparities, promote maternal health, reduce and treat maternal depression
  • Integrated Care for Kids (InCK) application submitted by DOH to Centers for Medicare and Medicaid Services (CMS) in June 2019
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Discussion

Kate Breslin
President and CEO,
Schuyler Center for Analysis and Advocacy

Jeffrey Kaczorowski, MD Professor of Pediatrics,
University of Rochester;
Senior Advisor, The Children´s Agenda

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First 1,000 Days in Context

Kate Breslin
President and CEO,
Schuyler Center for Analysis and Advocacy

Jeffrey Kaczorowski, MDProfessor of Pediatrics,
University of Rochester;
Senior Advisor, The Children´s Agenda

Renee Rider
Executive Director,
New York State Council on Children and Families

Related Initiative Activities

Initiative Overview Funding Leadership Where to learn more
Rockefeller Institute of Government´s partnership with First 1,000 Days Initiative Building and training First 1,000 Days communities; learning collaborative that identifies common lessons across First 1,000 Days pilot sites; pilot project evaluations. Pritzker Children´s Initiative Rockefeller Institute of Government Press Release
Raising New York Statewide coalition advancing policies that support families of infants and toddlers (1) Improving access to health and developmental care; (2) Improving access to high–quality affordable child care; (3) Helping more parents become financially secure; and (4) Building a system that works together for families (cross–system, cross–sector). Pritzker Children´s Initiative and Early Childhood Partners NYC Co–chaired by Melodie Baker (Erie/Niagara Birth to 8 Coalition and United Way of Buffalo & Erie County); Kate Breslin (Schuyler Center); and Heather C. Briccetti, Esq. (The Business Council of New York State). Staffed by The Education Trust– New York . https://raisingnewyork.org/
Preschool Development Grant Birth through Five Promoting a mixed–delivery system that provides access to high quality, equitable and comprehensive early care and learning environments and services essential for healthy development and lifelong success. Joint Federal HHS and DoE funds The New York State Council on Children and Families https://www.ccf.ny.gov/coun cil–initiatives/nysb5/
Home Visiting Coordination Initiative Model–neutral space for home visitors, supervisors, and administrators to discuss opportunities and challenges at the community and state level and learning opportunities—such as webinars—for providers to learn and expand skill sets in the current and pressing topic areas needed to best support families´ success. NYS Assembly Prevent Child Abuse New York https://www.nyshomevisitcoord.com/
NY Regents Early Childhood Blue Ribbon Committee Recommendations to transform NY´s birth to age eight early care and education system through: (1) Comprehensive Services for Children and Families; (2) Strengthening the Early Childhood Workforce; and (3) Statewide Supports and Infrastructure. New York State Education Department New York State Education Department http://www.nysed.gov/news/2018/board–regents–early–childhood–workgroups–blue–ribbon–committee–presents–final
Moving on Maternal Depression Center for Law and Social Policy (CLASP) is collaborating with states to advance policies that improve maternal depression prevention, screening, and treatment among mothers with young children. Health Foundation for Western and Central NY CLASP New York State Office of Mental Health and the Schuyler Center https://www.clasp.org/publication s/fact–sheet/moving–maternal–depression–momd–project–overview
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Closing

Nancy L. Zimpher, PhD
Professor, University at Albany

Beth Berlin
Acting Commissioner, NY State Education Department

Contact Information

Chad Shearer
Vice President for Policy Director, Medicaid Institute
cshearer@uhfnyc.org
(212) 494–0793
@chadeshearer

Suzanne Brundage
Program Director, Children´s Health Initiative
sbrundage@uhfnyc.org
(212) 494 – 0729
@suzbrundage

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