A major goal of the Children's Health Insurance Plan (CHIP) is to maximize the enrollment of eligible low-income children from working families. Unfortunately, access to health insurance does not assure access to quality health services. Changes in health care have made patients and providers increasingly concerned over quality of care issues. At the front-line, the only people who can assure the quality of care given are those actually providing the care. This includes patients and caregivers (parents, grandparents, foster parents, etc.) as well as individual providers (physicians, mid-levels, nurses, social workers, etc.) and institutions. As the primary stakeholders most impacted by the changing health care environment, patients, caregivers and providers need to be "vested" and supportive of new, emerging systems.
The goal of this project is inclusion. The focus is on Bureau of Primary Health Care (BPHC) Providers and how to give them a fair and appropriate role in determining and developing Comprehensive Systems of Quality Care in CHIP. Working collaboratively with the Bureau's Division of Programs for Special Populations, data were gathered through literature searches, an analysis of federal legislation, a review of submitted state plans and direct interviews. Interviews conducted spanned state and federal agencies, regional and national provider networks, advocacy and policy organizations and trade associations, as well as individual BPHC-Providers. The information gleaned was used to answer the following three questions:
1. What is the process of determining quality in CHIP?
2. Are BPHC-Providers involved in this process?
3. If not, how can the Bureau get interested providers involved?
The results found no consistent process, wide state variability, and a lack of BPHC-Provider involvement. Fortunately, there was a definite Bureau will and a BPHC-Provider desire to contribute. The conclusion is that a window of opportunity is opening, and the Bureau of Primary Health Care is well positioned to provide leadership and valuable BPHC-Provider resources toward assuring Comprehensive Systems of Quality Care in the Children's Health Insurance Plan.
To facilitate a BPHC-Provider / Bureau partnership, recommended strategies include the formation of an Advisory Board, a Fellowship, and a Breakthrough Series. These vehicles set the stage for process-oriented quality assessment, discussion, evaluation and assurance. There are the first steps toward the elusive and difficult goal of Patient-Centered / Provider Assured Value.
Theresa Watkins-Bryant, M.D., Chief, Child and Adolescent Division Bureau of Primary Health Care