Pediatric Sickle Cell Improvement Collaborative

Project start and end dates: 01/01/2021 – 09/30/2024

Background: Sickle cell disease (SCD) is a genetic condition that predominately affects minority populations in the US. Preventive care for children with SCD can significantly reduce the incidence of major complications such as stroke, sepsis, and pain. Despite long-standing evidence-based recommendations for preventive care and previous improvement efforts, there are large and persistent gaps in care delivery for children with sickle cell disease, particularly those with sickle cell anemia (SCA), the most severe form of sickle cell disease.  In partnership with the University of Michigan project team, Michigan Medicaid is establishing a pilot SCD Quality Improvement program in Southeast Michigan.  Through this unique and novel collaboration, all Medicaid health plans (MHPs) in the region with members having SCD will be financially incentivized to improve performance with transcranial Doppler screening, antibiotic prophylaxis, and hydroxyurea for all SCD patients in the region, regardless of health plan affiliation.  As such, plans will work together to achieve overall improvement. The Pediatric Sickle Cell Improvement Collaborative will share existing best practices, identify and implement novel improvement strategies, and establish common performance reporting processes to achieve improvement in preventive care delivery for this high-risk and vulnerable population.

Objectives: The primary outcome for this project is to improve the quality of care for children with SCA in Michigan. Intermediate outcomes are:

1. Develop a successful quality collaborative among MHPs to increase preventive service utilization among children with SCA
2. Support individual MHP QI efforts to increase preventive service utilization among children with SCA
3. Develop formative and summative evaluation tools and metrics for the Michigan Medicaid Program to assess the MHP Quality Collaborative
4. Develop a template and tool kit for the Michigan Medicaid Program to use with future MHP quality collaboratives that can be extrapolated to other chronic diseases

Research Topics & Methods: The project team is supporting the Medicaid health plans by:

• Facilitating Quality Collaborative meetings among quality improvement and other MHP personnel to support the development of common aims to improve SCA care, developing and utilizing key driver diagrams that identify interventions to increase performance rates of the 3 quality measures, and implementing PDSA cycles designed to include all children with SCA within the Prosperity Region.
• Supporting health plan participants individually and collectively during action periods of testing potential SCA improvement strategies (PDSA cycles) to enhance improvement and learning through quality improvement methodology and individualized coaching.
• Consulting with health plan representatives on the creation and modification of SCA narrative reports and other required documentation for the Michigan Medicaid Program to use for determining incentives
• Facilitating shared approaches to provider education and provider incentives to improve the quality of care for children with SCA regardless of how many different providers they may encounter

The project team is supporting the Michigan Medicaid Program by:

• Advising on the successes and challenges of collaborative learning among MHPs through the SCA initiative
• Providing clinical and quality improvement methodology expertise as needed for the MHP Quality Collaborative
• Developing evaluation tools and metrics for Michigan Medicaid Program use to evaluate the performance of MHPs individually and the MHP Quality Collaborative as a whole
• Developing a template for health plan collaboration for other diseases/conditions where this type of approach would be appropriate
• Reviewing MHP performance data on the SCA quality of care measures with Michigan Medicaid Program officials at regular intervals to determine impact of program

Implications: This framework can be used as a template for additional learning collaboratives to improve care for children and adults with other rare diseases. This program has the potential not only to be a model for the care of children and adults with uncommon conditions in Michigan, but in the nation as well. 

Funders: Michigan Health Endowment Fund

Collaborators: Michigan Department of Health and Human Services Managed Care Plan Division, Quality Improvement & Program Development Section (Michigan Medicaid Program), Aetna Better Health of Michigan, Blue Cross Complete, HAP Empowered, McLaren, Meridian, Molina Healthcare of Michigan, Priority Health Choice, Total Health Care, UnitedHealthcare Community Plan, Cori Davis/Shift Consulting.