Debbie I. Chang, MPH Senior Vice President and Chief Policy and - - PowerPoint PPT Presentation

Payment Reform for Children’s Healthcare: Aiming for Value and Integrated Care

Debbie I. Chang, MPH

Senior Vice President and Chief Policy and Prevention Officer

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Promoting a New Model of Paying for Value

Sick Care System

Pay for Volume Pay for Sickness Reactive (See children when they come in) Illness/Treatment Incremental

Health and Wellness System

Pay for Value Pay for Health Outcomes Proactive (Actively manage their care and prevent) Growing up healthy Transformational

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Health Cannot Stop Midstream

https://www.healthaffairs.org/do/10.1377/hblog20190115.234942/full/?utm_source=Newsletter&utm_medium=email&utm_content=Social+Determi nants+of+Health%3B+Putting+Patients++Goals+At+The+Center+Of+Care%3B+Digital+Health+Companies&utm_campaign=HAT

Examples

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Nemours CMMI Award in Delaware

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• Interact with

Families

• Collect Data

Navigator

• Identify

Themes

• Develop

Action Plans with Community

Integrator

• Bus Idling

Changes

• Medicaid

Formulary Changes

System Changes

Community Based Results in Delaware Potential Reach – Over 42,000 children

• Reducing school bus idling – 14,029 children impacted
• Medicaid drug formulary changes – 11,805 children impacted
• Smoke-Free Wilmington Ordinance – 19,224 children impacted
• 100% of Telamon Head Start childcare centers in Delaware are

asthma-friendly – 852 children impacted annually

• Healthy Homes/Integrated Pest Management >20,000 children

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Aligning Incentives for Success

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Strong Health Care Initiatives Collaboration with Community Partners to Address SDOH Changes to Systems and Policies Aligned Payment System Sustained and Improved Health Outcomes for Kids

Medicaid/CHIP and Early Care and Education Collaboration Initiatives

Nemours provides technical assistance to states to implement pilot projects that advance upstream prevention by strengthening integration across the Medicaid and ECE sectors. Projects:

• District of Columbia: Improve coordination between ECE providers and Medicaid

providers on completion of developmental screening, sharing information and ensuring that families receive follow-up services when needed.

• Maryland: Support planning for a childhood obesity prevention pilot in Head Start

to embed a dietician in a Head Start center to bill for services provided to Medicaid/CHIP enrollees through individual assessment and group nutritional counseling including helping the dietician enroll as a provider through the Managed Care Organization.

• Washington: Increase alignment of Medicaid and Department of Child, Youth,

and Family (DCYF) and deliver services with a unified approach in a manner that

• ptimizes family’s access.
• Florida & Georgia: Nemours is conducting initial scoping discussions with state

partners.

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National Academies Collaborative on Accountable Communities for Health for Children and Families

• Co-chairs: Nemours & Mental Health America
• Goal: to identify factors that have led to and can catalyze further

ACH models focused on children and families

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Moving Health Care Upstream www.movinghealthcareupstream.org

• Based on the notion that health systems can address persistent and

costly health inequities by moving “upstream”-- beyond the walls of hospitals and doctor’s offices and into the community, collaborating with community-based organizations to address the root causes of disease

• Supports health systems and other stakeholders in testing and

spreading strategies to move upstream, informing the field and accelerating upstream movement

• Collaborative effort that was co-led by Nemours and UCLA’s Center

for Healthier Children, Families & Communities and funded by The Kresge Foundation

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Launched First 1,000 Days on Medicaid Initiative, a cross- sector approach that features 10 evidence-based interventions found to promote child development by improving birth outcomes, addressing child/caregiver mental health, increasing home visiting, supporting early literacy in primary care and via other strategies

Leading Edge States Promoting Child Health

North Carolina is currently undergoing a major delivery system transformation that establishes robust care management, including requirements to address socio-economic drivers of health outcomes such as housing instability, food insecurity, lack of transportation and interpersonal violence

North Carolina New York

Coordinated Care Organizations (CCOs) work in conjunction with Early Learning Councils promote kindergarten readiness through alignment of quality measures, joint support for developmental screening, trauma-informed training on adverse childhood experiences

Oregon

Source: Manatt Health Strategies, LLC, LLC 12

Early Lessons

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Promoting Prevention in Medicaid: Lessons from “Pathways through Medicaid to Prevention” Project

Overcoming Barriers

• Understand what Medicaid can and

can’t pay for

• Demonstrate business case for

prevention

• Collaborate across sectors and

establish leadership buy-in

• Medical Loss Ratio changes allow for

investment in population health

• Address antiquated or non-existent

data collection or sharing infrastructure

Facilitators to Success

• High-level state, community and “c-

suite” executive champions

• Establishment of long-term prevention

and population health goals

• Alignment of Medicaid and child

serving organizations

• Incentives for shifting to value-based

payment

• Robust data collection and sharing

systems

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Year 1 Payment Lessons from National Academies Collaborative

Funders Should:

Catalyze testing of pediatric/dyadic payment models to address health- related social needs Support integrators and community financing mechanisms that promote shared accountability and goals Ensure public and private payers and managed care plans are engaged early as communities come together Invest in economic modeling and benefit cost estimation to assign value to prevention

Community Should:

 Cultivate relationships early on to focus

• n financial sustainability and leverage

integrator(s) to catalyze and sustain the work  Partner with states to develop innovative models and data integration pilots – leading to systemic change – and explore leveraging existing Medicaid authority and Sec. 1115 Medicaid waiver authority  Work with partners to design a balanced portfolio of interventions and deliver value across sectors over time  Test community-level financing mechanisms to align with the metrics included in value-based payment models

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Note: NAS does not endorse lessons.

Lessons from Moving Health Care Upstream

• Sustainability requires a combination of organizational policy and

practice change

• Change requires capacity building
• Dedicated time
• Knowledge and skills
• Buy-in at multiple levels is essential
• Leadership
• Front line
• Codifying in organizational strategic plan and dashboards
• External environment plays a role in opportunities for change
• Be strategic AND adaptive

Source: The Kresge Foundation

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Debbie I. Chang, MPH

Senior Vice President and Chief Policy and Prevention Officer

Deborah.chang@nemours.org 202-457-1455 www.nemours.org www.healthykidshealthyfuture.org www.movinghealthcareupstream.org

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