Money, Medicine, Metrics in Population Health for Kids Florida Health Grand Rounds 3/13/18 ………………..……………………………………………………………………………………………………………………………………..
Disclosure 1. Funding from DOE/CDC/NIH 2. National Academy of Medicine Travel and Meetings ………………..……………………………………………………………………………………………………………………………………..
Retail Rockets Up ………………..……………………………………………………………………………………………………………………………………..
Accountable Care Organizations ………………..……………………………………………………………………………………………………………………………………..
Children’s Hospital Associated Risk - Bearing Entities Partial/Full Risk Capitation Planned Risk or Shared Savings Only ………………..……………………………………………………………………………………………………………………………………..
Partners for Kids FFS CLAIMS EMR ACCESS Hospital Providers Contracted Network • Nationwide Children’s Hospital & Clinics Payer 204 Primary Care MD BOARD • • 54 Med/Surg Specialist Free-standing 427-bed hospital • Shared members • Employs 699 Providers (PAA) Ohio Medicaid with PFK Board • 101 Primary Care • 598 Specialists Molina CAPITATION • 37 Dental • ACO Medicaid HMO • 561 Med/Surg/Hosp Paramount HEDIS PERFORMANCE REPORTS • Partners For Kids Medicaid HMO • Not for Profit, taxable, sole member corp. • Delegated Case Management UnitedHealth Care CAPITATION • • Administrative and Services contract Medicaid HMO with Nationwide Children’s Hospital PMPM & QUALITY DATA Buckeye • CAPITATION POOL Medicaid HMO • Sub-capitation for BOARD CareSource NCH-based services EMR ACCESS • • Shared members Medicaid HMO • Quarterly savings with NCH Board reinvested Lives Ohio Medicaid MCO enrollees PMPM & QUALITY DATA • 34 Ohio counties • 306,473 pediatric lives Data • 297,658 CFC (<19) • 8,815 ABD (<21) EMR • All medical services, pharmacy Claims Valence (for all at-risk patients seen CLAIMS (on all at-risk and behavioral health • Claims processing vendor by NCH providers) DATA patients seen by • • 60% of risk population Population health software any provider) • Inpatient and outpatient
What is Partners For Kids? • Partnership between Nationwide Children’s and >1,000 physicians caring for children • Responsible for improving the quality of care and lowering costs for >320,000 children • Full financial risk through the 5 managed Medicaid plans as an “intermediary organization” ………………..……………………………………………………………………………………………………………………………………..
PFK’s Place in the System ………………..……………………………………………………………………………………………………………………………………..
Where the Money Goes for Care Ohio Managed Partners Nationwide Children’s Dept. of Care For Kids Medicaid Plans $100 $89 $41 Retained Outside Net Revenue • • Pay claims Entities $3 PAA • • • Provider $5 Dental $38 NCH • contracting $9 IP Hosp • • Member $6 OP services Services • • Profit $14 Doctors • $14 Rx Note: Amounts are approximate portions based on combined (ABD & CFC, Central & SE) PFK 2013 results, scaled to $100 PMPM ………………..……………………………………………………………………………………………………………………………………..
Who are PFK’s Children? • Over 320,000 children ages 0-18 • Urban Columbus to rural Appalachia • Poor (<200% federal poverty level) • More transient living situation • Higher incidence of chronic disease ………………..……………………………………………………………………………………………………………………………………..
Care Coordination ………………..……………………………………………………………………………………………………………………………………..
Keeping Complex Patients Home Desired Direction of Change HCIA Grant Med. Dir. of Care Awarded/Feeding Comprehensive Health Care Tube Task Force Coordination Service (CCHCS) Starts Dietician & Formed Expanded RN Join CC Team
Preventing Antibiotic Resistance Appropriate Treatment for Upper Respiratory Infection by Year - PFK Data (Dx 460 or 465 only) 100.00% 95.00% 91.21% 90.00% 87.32% % Compliance 85.00% 82.70% 82.74% 81.00% 81.00% 80.10% 80.00% URI Rate 90th %tile NCQA, 92.99% 75th %tile NCQA, 75.00% 90.29% 50th %tile NCQA, 85.86% 70.00% 2009 2010 2011 2012 2013 2014 2015+
Proactively Managing Epilepsy
Saving Society Money ………………..……………………………………………………………………………………………………………………………………..
National Leader for LGBTQ Equality, scoring a perfect 100 on the Municipal Quality Index For Population Growth (U.S. Census Bureau) (Human Rights Campaign, 2015) For Job Growth (U.S. Bureau of Labor Statistics) Top 10 City for Young Professionals (Forbes, March 2016) For Wage Growth (U..S. Labor Department) Intelligent Community of the Year No. 3 best city millennials (TIME, September 2015) (Intelligent Community Forum June 2015) 15th Fastest Growing City in the Country
Franklin County Opportunity Index Map RED = LEAST OPPORTUNITY/HIGHEST RISK ………………..…………………………………………………………………………………………………………………………………….. Source:http://kirwaninstitute.osu.edu/reports/2013/2013- Franklin-County-Childrens-Report.pdf
Neighborhood Distress and Child Development • Epigenetics/gene expression • Structural neuronal changes • Hormonal alterations • Cognitive, behavioral, social outcomes ………………..……………………………………………………………………………………………………………………………………..
HNHF Zone 06* Population: 1,856 493 23.6% of 1,021 F a m i l i e s housing units are owner-occupied ………………..…………………………………………………………………………………………………………………………………….. Source: 2012 Census Data for Census Tract 0056.10 = 100 People
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Healthy Homes Impacted more than 309 residential properties Before After ………………..……………………………………………………………………………………………………………………………………..
Vacancy Rate 2009 - 2016 30% 25% 20% 15% HNHF Impact Area Columbus MSA* 10% 5% 0% 2009 2013 2016 *Source: American Community Survey 1-year Estimates for 2009, 2013, & 2015 ………………..……………………………………………………………………………………………………………………………………..
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PAX Good Behavior Game for Elementary School Students 14% Decrease in suspension days per student ………………..……………………………………………………………………………………………………………………………………..
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More than 800 HNHF residents are employed by Nationwide Children’s ………………..……………………………………………………………………………………………………………………………………..
Neighborhood Hires 190 170 150 130 110 90 70 50 2013 2014 2015 2016 2017 ………………..……………………………………………………………………………………………………………………………………..
The Residences at Career Gateway 58 units of affordable housing combined with on-site workforce development training
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