Metrics in Population Health for Kids Florida Health Grand Rounds - - PowerPoint PPT Presentation

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Metrics in Population Health for Kids Florida Health Grand Rounds - - PowerPoint PPT Presentation

Sep 13, 2022 36 likes •391 views

Money, Medicine, Metrics in Population Health for Kids Florida Health Grand Rounds 3/13/18

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Money, Medicine, Metrics in Population Health for Kids

Florida Health Grand Rounds 3/13/18

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Disclosure

  • 1. Funding from DOE/CDC/NIH
  • 2. National Academy of Medicine Travel and

Meetings

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Retail Rockets Up

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Accountable Care Organizations

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Partial/Full Risk Capitation Planned Risk or Shared Savings Only

Children’s Hospital Associated Risk- Bearing Entities

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Partners for Kids

Providers

Nationwide Children’s Hospital & Clinics

  • Free-standing 427-bed hospital
  • Employs 699 Providers (PAA)
  • 101 Primary Care
  • 598 Specialists
  • 37 Dental
  • 561 Med/Surg/Hosp

Hospital

Partners For Kids

  • Not for Profit, taxable, sole member corp.
  • Delegated Case Management
  • Administrative and Services contract

with Nationwide Children’s Hospital

Lives Payer

Ohio Medicaid MCO enrollees

  • 34 Ohio counties
  • 306,473 pediatric lives
  • 297,658 CFC (<19)
  • 8,815 ABD (<21)
  • All medical services, pharmacy

and behavioral health Ohio Medicaid Molina

  • Medicaid HMO

CAPITATION

Data

EMR (for all at-risk patients seen by NCH providers)

  • 60% of risk population
  • Inpatient and outpatient

Claims (on all at-risk patients seen by any provider) CAPITATION POOL

  • Sub-capitation for

NCH-based services

  • Quarterly savings

reinvested Contracted Network

  • 204 Primary Care MD
  • 54 Med/Surg Specialist

FFS CLAIMS

ACO

BOARD

  • Shared members

with NCH Board BOARD

  • Shared members

with PFK Board CAPITATION HEDIS PERFORMANCE REPORTS EMR ACCESS PMPM & QUALITY DATA EMR ACCESS Valence

  • Claims processing vendor
  • Population health software

Paramount

  • Medicaid HMO

Buckeye

  • Medicaid HMO

CareSource

  • Medicaid HMO

UnitedHealth Care

  • Medicaid HMO

CLAIMS DATA PMPM & QUALITY DATA

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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”

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PFK’s Place in the System

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Where the Money Goes for Care

Ohio

  • Dept. of

Medicaid Managed Care Plans Partners For Kids Nationwide Children’s $100 $89 $41 Outside Entities

  • $5 Dental
  • $9 IP Hosp
  • $6 OP

Services

  • $14 Doctors
  • $14 Rx

Retained

  • Pay claims
  • Provider

contracting

  • Member

services

  • Profit

Net Revenue

  • $3 PAA
  • $38 NCH

Note: Amounts are approximate portions based on combined (ABD & CFC, Central & SE) PFK 2013 results, scaled to $100 PMPM

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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

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Care Coordination

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Keeping Complex Patients Home

Desired Direction
  • f Change
Care Coordination Expanded
  • Med. Dir. of
Comprehensive Health Care Service (CCHCS) Starts HCIA Grant Awarded/Feeding Tube Task Force Formed Dietician & RN Join CC Team
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Preventing Antibiotic Resistance

80.10% 81.00% 81.00% 82.70% 82.74% 87.32% 91.21% 70.00% 75.00% 80.00% 85.00% 90.00% 95.00% 100.00% 2009 2010 2011 2012 2013 2014 2015+ % Compliance

Appropriate Treatment for Upper Respiratory Infection by Year - PFK Data (Dx 460 or 465 only)

URI Rate 90th %tile NCQA, 92.99% 75th %tile NCQA, 90.29% 50th %tile NCQA, 85.86%
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Proactively Managing Epilepsy

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Saving Society Money

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For Population Growth (U.S. Census Bureau) For Job Growth (U.S. Bureau of Labor Statistics) For Wage Growth (U..S. Labor Department) Intelligent Community of the Year

(Intelligent Community Forum June 2015)

National Leader for LGBTQ Equality, scoring a perfect 100 on the Municipal Quality Index

(Human Rights Campaign, 2015)

Top 10 City for Young Professionals (Forbes, March 2016)

  • No. 3 best city millennials (TIME, September 2015)

15th Fastest Growing City in the Country

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Franklin County Opportunity Index Map

RED = LEAST OPPORTUNITY/HIGHEST RISK

Source:http://kirwaninstitute.osu.edu/reports/2013/2013- Franklin-County-Childrens-Report.pdf
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Neighborhood Distress and Child Development

  • Epigenetics/gene expression
  • Structural neuronal changes
  • Hormonal alterations
  • Cognitive, behavioral,

social outcomes

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HNHF Zone 06*

Population: 1,856

Source: 2012 Census Data for Census Tract 0056.10 = 100 People

493

F a m i l i e s

23.6% of 1,021 housing units are

  • wner-occupied
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Healthy Homes

Impacted more than

309

residential properties Before After

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………………..…………………………………………………………………………………………………………………………………….. 0% 5% 10% 15% 20% 25% 30% 2009 2013 2016

Vacancy Rate 2009 - 2016

HNHF Impact Area Columbus MSA*

*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

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………………..…………………………………………………………………………………………………………………………………….. 50 70 90 110 130 150 170 190 2013 2014 2015 2016 2017

Neighborhood Hires

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The Residences at Career Gateway

58

units of affordable housing combined with on-site workforce development training

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Addressing Social Determinants

  • Community to Clinic

– RWJ Accelerating Investment – Building Healthy Places Network – Oregon Coordinated Care Organizations

  • Clinic to Community

– CMMS Accountable Health Communities – Med Legal Partnership studies – Boston City EITC and tax program

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Medicaid Medical Directors 2018 Survey

  • Actively collecting or exploring social

determinants data

  • Housing and food most common focus
  • Purpose:

– Risk adjustment – Pay for process then eventually outcomes

  • Challenged and need help
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Next Generation Pediatrics

OLD NEW

PCMH PCMNeighborhood Anticipatory Guidance Visit Group Well Care, Online Care Physician Care Team Care Physician Focused Practice Retail/Consumer Focused Care Child Wellness Social Determinants of Health

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Policymakers

  • Calculating Capitation
  • Shared data----State/MCOs/Providers
  • Shared Savings Pools---Within and X-

sector

  • Aligned incentives—

State/MCOs/Providers

  • Population level metrics/social

determinants