The ABCs of ACOs for MCH May 30, 2013 For assistance: Please contact cmccoy@amchp.org or for web support 888-447-1119 option 2
Brief Notes about Technology Audio • Audio is available through your computer speakers or earphones. • For assistance, contact cmccoy@amchp.org or for web support 888-447-1119 option 2 2
Brief Notes about Technology Continued Questions • To submit questions at any time throughout the webinar , type your question in the chat box at the lower left-hand side of your screen. – Send questions to the Chairperson (AMCHP) – Be sure to include to which presenter/s you are addressing your question. 3
Technology Notes Continued Recording • Today’s webinar will be recorded • The recording will be available in a week on the AMCHP National Center for Health Reform Implementation website at www.amchp.org • A PDF version of the presenters' slides will also be available on the AMCHP website 4
Objectives Webinar attendees will: 1) Increase their knowledge of ACOs and ACOs that include MCH populations 2) Increase their understanding of how public health can play a role in ACOs 3) Will be able to identify strategies and resources to collaborate with, ACOs in their state
Evaluation Attendees will receive a link to a survey evaluation upon completion of this webinar. Please take a few minutes to share your feedback.
Featuring: Colleen A. Kraft , M.D., FAAP, Carilion Clinic, VA Cate Wilcox, MPH , Maternal & Child Health Section Manager, Public Health Division, Oregon Health Authority Don Ross , Policy & Planning Section Manager, Division of Medical Assistance Programs, Oregon Health Authority Marilyn Hartzell , M.Ed., Director, Oregon Center for Children and Youth with Special Needs 7
The ABCs of ACOs: Making Them Work for Maternal-Child Health Colleen A. Kraft, M.D., FAAP
Family-Centered Medical Home Parenting Support Early Early Child Intervention Mental Health Vulnerable Services children and families Acute Prevention, Care Building Home-visiting Health network Child and Family Early HeadStart & HeadStart Chronic Developmental Care Services Medically Complex Child Care Children Resource & Developmental Referral Services Agency Lactation Support
Accountable Care Organizations ACO Coordinates care for shared patients Hosp Medicare, Medicaid PCP Or private insurer Financial bonus Spec from savings ACO Attributes • Coordinates care for shared population of patients with the goal of meeting and improving on quality and cost benchmarks • Hires an administrator and establish a formal legal structure to work with payers, monitor performance, and collect any shared savings • Receives a financial bonus that is divided among its participants according to their agreement.
Traditional Medical Care and Financing “Un-accountable” care Low Cost Care No Coordination High Cost Care of Care • Primary Care • Hospitalizations • Preventive Care— • No incentive for communication • Procedures Screenings, Immunizations, and collaboration • Duplication of labs, studies, Anticipatory Guidance • No care coordinators procedures • “Gatekeeper” • No measurement of outcomes • Transportation = Ambulance • Health/Lifestyle counseling • No comparative effectiveness • Complications of Chronic • Home-based care Research Disease • Home visiting • No focus on population health • End of life care in an ICU • Primary Care access for • No co-location of services evenings and weekends • No self management services • No transportation Transparency of High Payment = Finances? Low Cost Care Outcome Measures? Plenty of Incentive Payment poor = Quality Reporting? No incentive Aligned incentives?
Accountable Care Reduce Cost Improve Coordination Improve Quality of Care of Care of Care--Investments • Improving Scientific Basis of • Develop robust primary care • HIT that promotes Healthcare Decisions access communication and interaction • Based on Comparative •. Streamline administrative • Office Care Coordinators Pediatric Effectiveness tasks • Home Visiting/Home Care Research • Co-management between • Primary Care-Ancillary Health • Measurement of Outcomes primary care and subspecialty co-location, including therapists, • Longitudinal data collection to avoid hospitalization dieticians, psychology and evaluation • Greater use of palliative care • Electronic portal for patient • Greater use of home care communication/collaboration and home visiting • Support for advanced primary • Payment Tied to Patient • Patient/Family portals care and Q/I initiatives Outcomes • Avoid duplication of care/HIT • Data management infrastructure • Based on Quality Measures to evaluate processes and outcomes Transparency of ACO Finances Shared System Savings Fair Payment for Patient/Family-Centered Aligned Incentives Low Cost Care Investment in Infrastructure Improved Outcomes
Accountable Care “Three-Part Aim” Better Health Better Care Lower Cost
Pediatric Accountable Care Optimize Health and Development Prevention of Adult Disease Reduce High Cost Care
Factors Affecting Child Health Medical Services 10% Environ- Health ment Behaviors 20% 50% Genetics 20% SOURCE: Healthy People 2010, US Department of Health and Human Services, 2000.
Health Innovation can be funded through an ACO • Extension of the Medical Home • In-home care management – Early Childhood – Oral Health – Prenatal – Asthma – Development/Behavioral Health
Carilion Clinic-Aetna Partnership Carilion Clinic ACO Carilion Private Clinic Practice Physicians Physicians 10
Virginia Medicaid Regions Update: 12/08/2011
ACO System Savings • Co-management between primary care and specialty • Less duplication of services • Tracking of “high utilizers” with care coordination to provide proactive care • Access to primary care, less use of ED and hospitalization
CORE Predictive Modeling from Aetna A Venn diagram , combining top 1% general risk with ED and IP risk, is used to help illustrate what risk groups a member falls into, and are they falling into multiple groups … Members who are top 1% general risk AND Members who are Top medium/high risk for IP 1% AND high risk for admit next 12 mos. Mbrs who are an ED visit next 12 Top 1% mos. Members who are Top 1% , high risk for an ED visit, AND medium/high risk for IP admit next 12 mos. Mbrs who are Mbrs who are Medium/High Members who are High Risk ED Risk IP high risk for an ED visit AND medium/high risk for IP admit next 12 mos.
Personalize the Profile for Medical Homes ED Risk Only Increasing Medical and Behavioral Complexity 3 ED Risk/IP Risk Only Top 1%/ Group 3: Top 1%/ 6 ED Risk/IP Risk IP Risk Only • Ave age 33 4 5 • 72% female Group 6: • PMPM $962 • Ave age 43 Group 4: Group 5: • 5 ED visits, 0.2 admits • PMPM $2425 • Ave age 49 • Ave age 53 • 32% asthma • 1.6 admits • PMPM $3908 • PMPM $3202 prevalence; 25% med • 7 IP bed days adherence (asthma) • 2.6 admits • 2 ED visits • 6 ED visits • 85% MH prevalence • 12 IP bed days • 2 admits • Low medical disease • 58% co-occurring • 7 ED visits • 10 IP bed days prevalence mental health and • 51% diabetes prevalence • 56% diabetes prevalence substance abuse • 85% MH prevalence • 73% MH prevalence • 41% MH prevalence • 52% with 5+ Rx • 62% co-occurring MH classes • 87% with 5+ Rx classes • 84% with 5+ Rx classes and SA • 5 Specialist visits • 20 Specialist visits • 19 Specialist Visits • 12 Specialist visits • 10 PCP visits • 10 PCP visits • 7 PCP visits • 9 PCP visits
Home Visiting Partner • Child Health Investment • Home Visiting with a Partnership of the Health Focus Roanoke Valley – Parents As Teachers – Oral Health – Asthma Management – Pregnant Moms – Behavioral Health
Home Visiting • Pediatric Asth
Care Management Design • Home Visiting Contract – Paid per member/per month • “High Touch”, in-person, in-home • Data Collected in home – HEDIS metrics – Health Outcomes – Reduced costs
Medical Home
Oral Health and Fluoride Varnish • Begin with a Grin!
Asthma Case Management • Assess environment, modifications • Smoking cessation • Observe inhaler use • Asthma control assessment • Asthma action plan and education • Transportation to visit
Behavioral Health • Prenatal to age 7 • Perinatal/postpartum depression screening • Connection to services for parents and children at-risk and diagnosed • Transportation to visits
Results
In-Home Screening
Ready for School?
Pediatric Asthma
Home Visiting Intervention Pilot
Home Visiting = In-Home Prenatal Care Management IDEA AIM STATEMENT • Poverty is a risk factor for • Reduce the number of poor maternal and newborn infants born at <37 weeks outcomes. gestation and low birth weight (<2500 grams) by • What if every mother with 30% by December 2012 Medicaid had a Home Visitor utilizing home visitors as in- to provide support, home case managers. education, transportation? • How would this impact health of the next generation?
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