III

Lovelace Community Health Plan

Change:

Cycle 1:

Lovelace approached the Medicaid Department of the Health and Human Services

Department (DHHS) and requested permission to reimburse for use of the ASQ

screener.

Cycle 2:

DHHS determined that Lovelace would not receive extra reimbursement from the state

and thought that Lovelace could reimburse for the ASQ screener as an enhancement

to their services.

Cycle 3:

The Lovelace BCAP team presented a convincing economic justification to upper man 

agement at Lovelace and as a result, Lovelace decided to pilot a $10 reimbursement

per questionnaire only at the pilot sites.

Cycle 5:

This incentive led to improved screening and referral rates and, as a result, the reim 

bursement was expanded to all Medicaid providers at Lovelace.

Cycle 6:

Lovelace went back to DHHS and convinced state policy makers to reimburse an addi 

tional amount ($14) for standardized developmental testing.

Results:

Providers have responded positively to the additional reimbursement and claims for

standardized developmental screening continue to increase across all provider sites.

Lovelace indicates a modest improvement in screening and referral rates.  The referral

rate measures have been adopted by the State of New Mexico to evaluate their Family

Infant Toddler program, which will allow Lovelace to compare its results with the state.

SUSTAINING AND DIFFUSING THE PROGRAM

Positive provider and member feedback has encouraged Lovelace to spread lessons

learned to provider offices beyond the four pilot sites. Providers at the pilot sites are

now routinely using the ASQ screener and therefore best practices piloted in Medicaid

are impacting children from the commercial sector as well. New Mexico's Department

of Health and Human Services has also been very interested in the progress demon 

strated at Lovelace and is considering implementation of referral fax back program

piloted at Lovelace at a statewide level. And lastly, Lovelace has extended the success 

es of its pilot programs in a variety of ways. Lovelace has made presentations to

provider groups, the Governor's Cabinet and the Legislature's Children's Cabinet about

the need to improve child development services in New Mexico and the importance of

timely screening and referrals.  These efforts have led to a statewide policy change

and reimbursement for standardized screening.

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