The Partners For Kids Journey OSU HSMP Management Institute - PowerPoint PPT Presentation

The Partners For Kids Journey OSU HSMP Management Institute October 28, 2016 ………………..……………………………………………………………………………………………………………………………………..

Presentation Objectives • What is Partners For Kids? • Why was Partners For Kids created? • What are Partners For Kids’ goals? • How is Partners For Kids structured? • How does funds flow work? • What have we learned? ………………..……………………………………………………………………………………………………………………………………..

What is Partners For Kids? • Physician-Hospital Organization • Accountable Care Organization (with a twist) – Member lives attributed to PFK based on the member ’s: • Participation in a managed Medicaid plan • Age • County of residency – Physician’s contract status with PFK is not a factor ………………..……………………………………………………………………………………………………………………………………..

By The Numbers… • Network – 100 NCH-employed and 200 community PCP’s – 700 NCH-employed and 50 community specialists – 1 hospital (Nationwide Children’s Hospital) • Members – 330,000 children ………………..……………………………………………………………………………………………………………………………………..

By The Numbers… • Health Plans – 5 managed Medicaid plans in Ohio (full-risk capitation, delegated credentialing, delegated care coordination) – 9 commercial plans (fee-for-service, delegated credentialing) • Service area – 34 counties ………………..……………………………………………………………………………………………………………………………………..

By The Numbers…

Why Was Partners For Kids Created? • Managed Medicaid ………………..……………………………………………………………………………………………………………………………………..

Why Was Partners For Kids Created? Accountable Care Org. (Population Health) Patient Membership 400 Managed Care Thousands of Members 350 Strategy 300 250 Contracting Strategy 200 150 100 50 0 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 ………………..……………………………………………………………………………………………………………………………………..

Value is Driving New Business Models and Partnership Strategies Quality Delivery Safety Value Cost

Value is Driving New Business Models and Partnership Strategies Incentive Shared based FFS Savings / P4P FFS ACO FFS COM PFK

What Are Partners For Kids’ Goals? Primary: • Improving the health of children through high-quality, efficient and innovative care and community partnerships Secondary: • Demonstrate that a pediatric ACO is viable model ………………..……………………………………………………………………………………………………………………………………..

PFK Population vs. Total Population PFK Members within County Population % of Total PFK Members Total 0-17 County Population = Ages 0-17* Population ** PFK VINTON 1,764 2,735 64.5% MEIGS 2,791 4,567 61.1% PIKE 3,625 6,003 60.4% SCIOTO 10,195 17,380 58.7% FAYETTE 3,534 6,148 57.5% MARION 7,643 13,694 55.8% JACKSON 3,987 7,347 54.3% HOCKING 3,382 6,243 54.2% JEFFERSON 7,213 13,456 53.6% LAWRENCE 7,338 13,768 53.3% MORGAN 1,471 2,769 53.1% MUSKINGUM 10,957 20,720 52.9% GALLIA 3,843 7,302 52.6% ROSS 8,633 16,662 51.8% CRAWFORD 4,760 9,472 50.3% COSHOCTON 3,735 7,717 48.4% PERRY 4,496 9,395 47.9% FRANKLIN 143,772 302,857 47.5% GUERNSEY 4,266 9,035 47.2% ATHENS 5,372 11,454 46.9% NOBLE 904 1,968 45.9% MONROE 1,310 2,887 45.4% HARRISON 1,430 3,217 44.5% WASHINGTON 5,449 12,365 44.1% BELMONT 5,598 12,745 43.9% MORROW 2,703 6,158 43.9% PICKAWAY 4,584 11,613 39.5% LICKING 13,277 35,606 37.3% KNOX 5,036 13,874 36.3% LOGAN 4,185 11,722 35.7% FAIRFIELD 11,380 32,476 35.0% MADISON 3,649 11,559 31.6% UNION 2,746 10,499 26.2% DELAWARE 5,888 51,635 11.4% PFK Counties 310,916 707,048 44.0%

How Is Partners For Kids Structured? • Formed as a joint venture (PHO) between Nationwide Children’s Hospital, NCH- employed physicians and contracted, community physicians in 1994 • 501(c)(3) as of January 2016 • The Ohio Department of Insurance considers PFK to be an “intermediary organization” – accepts financial risk, but not a health plan; required to maintain reserves and stop loss coverage ………………..……………………………………………………………………………………………………………………………………..

Governance • Board of Directors comprised of 17 individuals • 9 appointed by Nationwide Children’s Hospital (including 1 parent of a child enrolled in Medicaid) • 8 elected from PFK provider network (3 primary care at least one from a community practice; 2 medical specialists, 2 surgical specialist, 1 hospital-based specialty) ………………..……………………………………………………………………………………………………………………………………..

Provider Network and Member Access Out of Network Providers Providers Directly Contracted with Payors PFK Member Community Physicians NCH and NCH- Employed Physicians

Division of Responsibilities * Delegated for 3 of 5 health plans ………………..……………………………………………………………………………………………………………………………………..

Partners For Kids Departments Community Data Resource Care Navigation Wellness Center Operations and Office of the Network Payor Relations Medical Director Development ………………..……………………………………………………………………………………………………………………………………..

Flow of Funds PFK receives capitated payments for each child in the program and pays for their medical costs across the care spectrum ………………..……………………………………………………………………………………………………………………………………..

Pay for Performance Top to Bottom Alignment • State targets measures ODM • Health Plans incentivized Health Plans • PFK engaged in performance based contract PFK Doctors • Physician incentives on HEDIS and Quality ………………..……………………………………………………………………………………………………………………………………..

Provider Incentive Plan Summary • Metrics adjusted annually by Incentive Committee (includes provider representation) • Incentives paid quarterly • Continues to shift to outcomes-based measures ………………..……………………………………………………………………………………………………………………………………..

Provider Incentive Sample Quality – Health Supervision Visits $155.07 per • Members = 12-18 years old successful patient • For patients who were eligible and were non-complaint in the prior year preceding the qualifying visit Quality – Health Supervision Visits $47.86 per • Members = 15 months old successful patient • Members = 3-6 years old Pharmacy Shared Savings 25% (paid semi- • For practices which meet or exceed the established annually; paid per benchmark, receive a portion of the dollars saved through practice) improvements in prescribing patterns Meeting with Provider Relations Rep to review current year Must complete to incentive plan by April 30 be eligible for any incentive payouts ………………..……………………………………………………………………………………………………………………………………..

What Have We Learned? • There are advantages in being a provider- based ACO. ………………..……………………………………………………………………………………………………………………………………..

What Have We Learned? NCH PFK Leadership Leadership Director of Care Coordination NCH “Global” NCH Inpatient PFK Care Care Care Coordination Coordination Coordination

Quality Initiatives in the NICU Conservative PDA Decreased LOS Management for and Decreased Gastroschisis Ligations Patients Prevention IPAC of initiative necrotizing enterocolitis Decreased LOS for NAS Patients Decrease Parent engagement, utilization of Feeding inhaled nitric enhancement, and oxide readmissions

Complex Care Cohort Utilization Census Patient Days per 100 Feeding Tube Patients

Preventing Antibiotic Resistance

What Have We Learned? • Accurate, timely and reliable data is essential. ………………..……………………………………………………………………………………………………………………………………..