DC: Bridging the Data Divide
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- Agnes Lawrence
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1 DC: Bridging the Data Divide E S T A B L I S H I N G A D A T A S H A R I N G A G R E E M E N T B E T W E E N T H E S C H O O L S, H E A L T H D E P A R T M E N T, A N D M E D I C A I D T O I M P R O V E C O O R D I N A T I O N A N D T A R G E T E D O U T R E A C H A N D S E R V I C E D E L I V E R Y
2 Presenter Disclosures C h a r l i s s a Q u i c k, M S A, B S N, R N D O H S c h o o l H e a l t h D i v i s i o n C h i e f C o l l e e n S o n o s k y, J D D H C F A s s o c i a t e D i r e c t o r f o r C h i l d r e n s H e a l t h S e r v i c e s D I S C L O S U R E : N o r e l a t i o n s h i p s t o d i s c l o s e.
3 Objectives O b j e c t i v e 1 : I d e n t i f y t h e t w o l a w s t h a t i m p a c t p r i v a c y o f s c h o o l h e a l t h d a t a ( F E R P A a n d H I P A A ) a n d u n d e r s t a n d t h e k e y r e q u i r e m e n t s o f e a c h. O b j e c t i v e 2 : U n d e r s t a n d h o w m e e t i n g t h e j u r i s d i c t i o n a l r e q u i r e m e n t f o r s c h o o l s t o c o l l e c t s t u d e n t h e a l t h i n f o r m a t i o n p r o v i d e s t h e f r a m e w o r k t o s h a r e n e e d e d d a t a, w h i l e m e e t i n g t h e n e e d s a n d o b l i g a t i o n s o f m u l t i p l e a g e n c i e s t o i m p r o v e c h i l d a n d a d o l e s c e n t h e a l t h. O b j e c t i v e 3 : I d e n t i f y a c t i o n s t e p s r e q u i r e d t o i n i t i a t e a s i m i l a r a g r e e m e n t i n y o u r h o m e j u r i s d i c t i o n, i n c l u d i n g i d e n t i f y i n g a p p l i c a b l e s t a k e h o l d e r s, p o t e n t i a l h u r d l e s, a n d s o l u t i o n s.
4 Setting the Stage: Who We Are and Why We Work Together
5 Who We Are: District of Columbia Non-DCPS, DCPS, Non Medicaid 47% Medicaid 53% 85,403 School-Aged Children in DC Of 47,548 students enrolled in DCPS in SY15-16, 53% were also enrolled in Medicaid
6 Who We Are DOH DCPS Meet Health Needs of DC Children DHCF
7 Medicaid Children in DCPS - Feb ,289 DCPS children enrolled in Medicaid 17% visited their PCP and dentist, and submitted a valid universal health certificate and oral health assessment form to their school
8 Medicaid Children in DCPS In 2015: 57% of DCPS Medicaid children visited their PCP Less than half have a valid universal health certificate on file. 55% of DCPS Medicaid children visited their dentist 38% have a valid oral health assessment form on file.
9 Medicaid Children in DCPS - February % The percentage of DCPS Medicaid children between the ages of 11 and 20 who attend a school with a school-based health center
10 Step 1: Identify the Problem
11 What s the Problem? D C P S a n d D H C F e a c h h a v e i n s t i t u t i o n a l r e q u i r e m e n t s t o m o n i t o r a n d m e e t t h e h e a l t h n e e d s o f D i s t r i c t o f C o l u m b i a c h i l d r e n. D O H, a s t h e p u b l i c h e a l t h a g e n c y, s u p p o r t s m e e t i n g t h e s e r e q u i r e m e n t s t h r o u g h v a r i o u s p r o g r a m s. L a c k o f d a t a s h a r i n g a n d c o l l a b o r a t i o n r e s u l t e d i n d u p l i c a t i o n o f e f f o r t s a n d i n a c c u r a t e d a t a r e g a r d i n g r e c e i p t o f b a s i c h e a l t h s e r v i c e s b y D C c h i l d r e n.
12 Documentation Collection Challenges W E L O V E P A P E R!!! UHC/OHA
13 So this happens W H A T I S T H I S I N Y O U R B A C K P A C K?!?! I V E B E E N D R I V I N G A R O U N D W I T H T H E S E P A P E R S I N T H E C A R F O R W E E K S!
14 Step 2: Identify With Whom You Want to Collaborate W h o h a s t h e i n f o r m a t i o n y o u n e e d? W h o s h o u l d b e c o r e p a r t n e r s? W h o a r e t h e s t a k e h o l d e r s t h a t n e e d t o b e c o n s u l t e d?
15 Why Work Together? S t u d e n t s b e n e f i t f r o m t h e c o l l a b o r a t i o n. A c h i e v e o u r g o a l s : Healthy students who are successful in school and develop healthy habits. Students with the greatest needs have the services that meet those needs.
16 Step 3: Identify the Goal W h a t d a t a / r e s o u r c e s d o e s e a c h p a r t n e r h a v e a v a i l a b l e? W h a t d a t a / r e s o u r c e s d o y o u w a n t t o e x c h a n g e? H o w w o u l d y o u w a n t t o u s e t h a t d a t a / r e s o u r c e s?
17 Step 4: Identify the Barriers
18 Family Educational Rights and Privacy Act (FERPA) P r o t e c t s p r i v a c y o f s t u d e n t s e d u c a t i o n a l r e c o r d s E d u c a t i o n a l r e c o r d s i n c l u d e : Student information, including immunization records, school health records, etc. Information about what school a student attends Attendance data Academic data
19 Health Insurance Portability and Accountability Act (HIPAA) R e q u i r e s c o v e r e d e n t i t i e s t o p r o t e c t i n d i v i d u a l h e a l t h r e c o r d s a n d i d e n t i f i a b l e h e a l t h i n f o r m a t i o n I n c l u d e s c o n d i t i o n s o n u s e s a n d d i s c l o s u r e s t h a t m a y b e m a d e w i t h o u t c o n s e n t, i n c l u d i n g : public health activities, legal obligations and institutional requirements, and care coordination
20 Step 5: Develop an Agreement that Addresses the Barriers I d e n t i f y t h e i n s t i t u t i o n a l r e q u i r e m e n t s o f e a c h p a r t n e r, w i t h a p p r o p r i a t e j u r i s d i c t i o n a l l a w s, r e g u l a t i o n s, e t c., i f a p p l i c a b l e C o n v e n e s t a k e h o l d e r s e a r l y a n d o f t e n! T h i n k t h r o u g h a n y t h i n g a n d e v e r y t h i n g t h a t y o u m i g h t w a n t t o d o, s h a r e, c o l l a b o r a t e o n C u l l d o w n t o t h e k e y p a r t s e v e r y o n e c a n a g r e e t o S e e k a p p r o v a l f r o m a l l r e s p e c t i v e a g e n c i e s
21 Applicable Law D C O F F I C I A L C O D E S T U D E N T H E A L T H C A R E A C T O F R e q u i r e s d o c u m e n t a t i o n o f p e r i o d i c p h y s i c a l e x a m i n a t i o n, d e n t a l e x a m i n a t i o n s, i m m u n i z a t i o n s, a n d b l o o d l e a d s c r e e n i n g D C O F F I C I A L C O D E H E A L T H Y S C H O O L S A C T O F A m e n d e d t h e S t u d e n t H e a l t h c a r e A c t o f t o r e q u i r e a n n u a l p h y s i c a l e x a m i n a t i o n
22 Applicable Law D C O F F I C I A L C O D E P U B L I C S C H O O L N U R S E A S S I G N M E N T A C T R e q u i r e s a m i n i m u m o f 2 0 h o u r s p e r w e e k o f r e g i s t e r e d n u r s i n g ( R N ) c o v e r a g e i n p u b l i c s c h o o l s. L i c e n s e d p r a c t i c a l / v o c a t i o n a l n u r s e ( L P N / L V N ) s t a f f m a y s u p p l e m e n t t h i s c o v e r a g e t o m e e t t h e r e q u i r e m e n t, b u t t h e y m u s t w o r k u n d e r t h e s u p e r v i s i o n o f a n d c o l l a b o r a t e w i t h t h e r e g i s t e r e d n u r s e
23 Applicable Law S E C T I O N ( A ) ( 4 ) ( B ) A N D ( R ) O F S O C I A L S E C U R I T Y A C T : E A R L Y A N D P E R I O D I C S C R E E N I N G, D I A G N O S T I C, A N D T R E A T M E N T ( E P S D T ) S E R V I C E S B E N E F I T R E Q U I R E M E N T S P e d i a t r i c c o m p o n e n t o f t h e M e d i c a i d b e n e f i t E P S D T h a s t h r e e m a j o r e l e m e n t s : Access Well-Child Visit Screenings and Education Diagnosis and Treatment
24 Applicable Law 4 2 C F R ( U T I L I Z A T I O N O F P R O V I D E R S A N D C O O R D I N A T I O N W I T H R E L A T E D P R O G R A M S ), 42 C F R ( C O O P E R A T I V E A G R E E M E N T S W I T H M C H P R O G R A M, A N D / O R S E C O F T H E S T A T E M E D I C A I D M A N U A L ( C O O R D I N A T I O N W I T H R E L A T E D A G E N C I E S A N D P R O G R A M S )
25 Developing the Agreement Memorandum of Agreement (MOA) developed between three agencies to share data to promote outreach for health services and target resources in schools Programmatic Staff from each agency worked to develop language, shepherd through Agency approval processes District Privacy Officers and General Counsels were included to ensure HIPAA/FERPA compliance
26 Step 6: Approval Process
27 Step 7: Implementation
28 Implementation: Data Sharing DCPS: -enrollment list - records of health form submission DHCF: - Medicaid status - Date of last WCV and dental visit - MCO assignment DOH: - Immunization Compliance Data Data sources are combined to identify the schools with the greatest gaps in service utilization and highest Medicaid enrollment.
29 Implementation: Collaborating on Outreach
30 Implementation: Collaboration on Services B e t w e e n S e p t e m b e r a n d F e b r u a r y i n S Y , t h e D O H O r a l H e a l t h P r o g r a m p r o v i d e d s e r v i c e s t o 1, s t u d e n t s i n 4 2 D C P S s c h o o l s S c h o o l s w e r e p r i o r i t i z e d b a s e d o n s h a r e d d a t a
31 Success so Far: Data-Driven Decision Making
32 Sample: School Health Snapshot
33 Success So Far: Managed Care Collaboration D H C F d e v e l o p e d M C O s p e c i f i c s n a p s h o t s M C O s r e c e i v e s c h o o l e n r o l l m e n t i n f o r m a t i o n f o r t h e i r m e m b e r s T a r g e t o u t r e a c h t o s t u d e n t s a t s c h o o l s w i t h s c h o o l - b a s e d h e a l t h c e n t e r s a n d t h o s e e n r o l l e d i n H e a d S t a r t p r o g r a m s P l a n h e a l t h e v e n t s a n d e d u c a t i o n e f f o r t s, u s i n g m e m b e r s c h o o l e n r o l l m e n t d a t a
34 Still more to do! I n c r e a s e d a t a d i s s e m i n a t i o n t o k e y s t a k e h o l d e r s I m p r o v e t r a c k i n g o f i m p a c t Increased service utilization and form submission Student level impact on academic indicators I n c r e a s e s t u d e n t l e v e l c o o r d i n a t i o n
35 Questions?
36 We re Here to Help! Diana K. Bruce DC Public Schools Director of Health and Wellness Charlissa Quick DC Department of Health School Health Division Chief Valentine Breitbarth DC Public Schools Manager of Health Services Colleen Sonosky DC Department of Health Care Finance Associate Director, Children s Health Services Colleen.sonosky@dc.gov
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