The ABCs of ACOs for MCH May 30, 2013 For assistance: Please - - PowerPoint PPT Presentation
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
For assistance: Please contact cmccoy@amchp.org
Audio
speakers or earphones.
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Questions
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.
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Recording
National Center for Health Reform Implementation website at www.amchp.org
available on the AMCHP website
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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
Attendees will receive a link to a survey evaluation upon completion of this webinar. Please take a few minutes to share your feedback.
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
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Colleen A. Kraft, M.D., FAAP
Child and Family
Developmental Services Home-visiting network Early Intervention Child Care Resource & Referral Agency Early HeadStart & HeadStart Early Child Mental Health Services
Prevention, Building Health Acute Care Chronic Care Developmental Services
Parenting Support Lactation Support
Vulnerable children and families Medically Complex Children
ACO Hosp PCP Spec
Coordinates care for shared patients
Medicare, Medicaid Or private insurer
Financial bonus from savings ACO Attributes
meeting and improving on quality and cost benchmarks
payers, monitor performance, and collect any shared savings
according to their agreement.
Low Cost Care
Screenings, Immunizations, Anticipatory Guidance
evenings and weekends No Coordination
and collaboration
Research
High Cost Care
procedures
Disease
Low Cost Care Payment poor = No incentive
Transparency of Finances? Outcome Measures? Quality Reporting? Aligned incentives?
High Payment = Plenty of Incentive
Reduce Cost
access
tasks
primary care and subspecialty to avoid hospitalization
and home visiting
Improve Coordination
communication and interaction
co-location, including therapists, dieticians, psychology
communication/collaboration
care and Q/I initiatives
to evaluate processes and
Improve Quality of Care
Healthcare Decisions
Pediatric Effectiveness Research
and evaluation
Outcomes
Fair Payment for Low Cost Care Transparency of ACO Finances Patient/Family-Centered Investment in Infrastructure Shared System Savings Aligned Incentives Improved Outcomes
Lower Cost
Reduce High
SOURCE: Healthy People 2010, US Department of Health and Human Services, 2000.
Medical Services 10% Environ- ment 20% Genetics 20% Health Behaviors 50%
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Carilion Clinic
ACO
Carilion Clinic Physicians Private Practice Physicians
Mbrs who are Top 1% Mbrs who are High Risk ED Mbrs who are Medium/High Risk IP
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% AND high risk for an ED visit next 12 mos. Members who are Top 1% , high risk for an ED visit, AND medium/high risk for IP admit next 12 mos. Members who are top 1% general risk AND medium/high risk for IP admit next 12 mos. Members who are high risk for an ED visit AND medium/high risk for IP admit next 12 mos.
Increasing Medical and Behavioral Complexity
Group 3:
admits
prevalence; 25% med adherence (asthma)
mental health and substance abuse
classes
Group 4:
Group 6:
prevalence
and SA
Group 5:
ED Risk Only ED Risk/IP Risk Only Top 1%/ ED Risk/IP Risk Top 1%/ IP Risk Only
– Parents As Teachers – Oral Health – Asthma Management – Pregnant Moms – Behavioral Health
IDEA
poor maternal and newborn
Medicaid had a Home Visitor to provide support, education, transportation?
AIM STATEMENT
infants born at <37 weeks gestation and low birth weight (<2500 grams) by 30% by December 2012 utilizing home visitors as in- home case managers.
Virginia
birth
8%
Roanoke/Allegheny
region
10.1%
Measure
Health Care Cost
Percent of infants born at < 37 weeks gestation
O
Percent of infants born between 34 and 36 weeks gestation (late preterm)
O
Birth weight term infants <2500 grams
O
Percent of Pregnant Moms participants who smoke that stopped smoking
O
Percent of Pregnant Moms participants who start prenatal care in the first trimester
P
Percent of Pregnant Moms participants who attend all the recommended prenatal visits
P
Percent of Pregnant Moms participants who are uninsured
P
Percent of Pregnant Moms participants identified with depression
P
Percent of Pregnant Moms participants connected to treatment for depression
P
Cost of Care
C
Percent Goal = 90%
Percent Goal = 60%
Percent Goal = 16%
<37wk 34-36 wk Goal
Note: One premature infant March 19-May 10
– HEDIS measures – Compliance with Asthma guidelines, ER and hospital admissions, missed school and work days – Co-locate HV teams in OB and Pediatric practices – Feasibility of project replication as ACO expands – Development and school readiness of birth cohort
Don Ross
Oregon Division of Medical Assistance Programs
Cate Wilcox
Oregon Public Health Division
Marilyn Hartzell
Oregon Child Development and Rehabilitation Center, OHSU
Health System Transformation and Opportunities for Preconception Health
Basics of Coordinated Care Organizations Public Health Role in CCOs (ACOs)
MCH Metrics Preconception Health (One Key Question)
Opportunities for Children and Youth with Special
Health Care Needs to work with CCOs (ACOs)
www.health.oregon.gov
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www.health.oregon.gov
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www.health.oregon.gov
Physical health, behavioral health, dental health Get better outcomes:
Health equity Prevention Social determinants of health: education, employment
MH: Supported Employment
Community health workers/non-traditional health
workers
Collaborate and Integrate with other health and
human services (e.g. long term care; public health; schools)
www.health.oregon.gov
Current system
MCO/MHO/DCO/FFS Payments based on actions No incentives for health outcomes
CCO global budget
One budget Accountable to health outcomes/metrics Local vision, shared accountability, shared savings Flexibility to pay for the things that keep people healthy www.health.oregon.gov
State law says governance must include:
Major components of health care delivery system Entities or organizations that share in financial risk At least two health care providers in active practice
Primary care physician or nurse practitioner Mental health or chemical dependency treatment
provider
At least two community members At least one member of Community Advisory Council
www.health.oregon.gov
ACOs have distinct features:
ACOs developing around health systems, not payers ACOs in the ACA are aimed primarily at Medicare
savings
Providers in ACOs share in Medicare savings in:
Medicare Shared Savings Model Advance Payment ACO Model Pioneer ACO Model
CCOs are accountable to the state, and local
community
Medicaid enrollment in CCOs is required
www.health.oregon.gov
Majority of members must be consumers. Must include representative from each county government in
service area.
Duties include Community Health Improvement Plan and
reporting on progress.
Variety of requirements in statute:
publicly funded providers for payment for certain services (immunizations, STIs and other communicable diseases)
HIV and AIDS-related services from fee-for-service providers, as well as maternity case management if CCO cannot do it
entities for authorization and payment of other services including maternity case management, prenatal care, school-based clinics, services provided through schools and Head Start programs, screening services for early detection of health problems in vulnerable populations www.health.oregon.gov
Variety of requirements in contract:
authority, community based organizations and hospital systems for community health assessment and development of community health improvement plan
recommended in Bright Futures guidelines
healthy nutrition, tobacco prevention, suicide prevention, and local public health and health promotion planning efforts
demographically diverse community partners to address the causes of health disparities. www.health.oregon.gov
Reduction of disparities - report all other metrics by race and
ethnicity
Member/patient Experience of care Health and Functional Status among CCO enrollees Rate of tobacco use Obesity rate Outpatient and ED utilization Potentially avoidable ED visits Ambulatory care sensitive hospital admissions Medication reconciliation post discharge All-cause readmissions Alcohol misuse – SBIRT Initiation & engagement in alcohol and drug treatment
www.health.oregon.gov
Mental health assessment for children in DHS custody Follow-up after hospitalization for mental illness Effective contraceptive use among women who do not desire
pregnancy
Low birth weight Developmental Screening by 36 months Planning for end of life care Screening for clinical depression and follow-up Timely transmission of transition record Care plan for members with Medicaid-funded long-term care benefits
www.health.oregon.gov Metrics in bold can be applied to Preconception Health
Designed to achieve quick return on investment to
meet the federal requirements
Maternal and Child Health is imbedded in many, but
not necessarily called out
www.health.oregon.gov
Important to be at the table—we have a lot to offer!
MCH brings the sustainability factor MCH brings the lifelong wellness factor www.health.oregon.gov
Look at a broad range of standards of care/practice
HP2020, Bright Futures, USPSTF, Title V priorities
Include Adolescent measures Look for means of coding/tracking the measure
www.health.oregon.gov
Targeted measures for MCAH populations Oral Health Positive Parenting Sleep hygiene Positive Youth Development Family violence prevention Safety/Injury prevention Pregnancy intendedness
www.health.oregon.gov
Do you plan on getting pregnant in the next 12
months?
If yes, preconception health care If no, contraceptive health care www.health.oregon.gov
Pay attention to Electronic Health Record requirements
in the ACA
The concept of “Meaningful Use” introduces more complex
reporting to public health by Electronic Health Record users.
Public health needs to be ready to be
able to receive data from providers.
Public health needs to be ready to be
able to provide data to providers.
www.health.oregon.gov
Join the conversation – get to know the ACOs/CCOs Educate ACOs about the population of children with
special health care needs
Who are CYSHN?
Complex Broad and inclusive definition Commonalities of needs across the population of indivduals
Educate ACOs about how to identify CYSHN within a
system of care
Screeners Complexity Scales
www.health.oregon.gov
Family-Professional Partnerships
Patient Engagement is not Family-Professional Partnership Family Professional Partnerships involve: Shared knowledge and expertise Mutual respect Collaborative problem solving www.health.oregon.gov
Advocacy and Education
Encourage family leaders, F2F HICs, community
leaders to join the Advisory Committees
Support family leaders in their work with ACOs
The Family Voice
www.health.oregon.gov
Effective Systems of Care for CYSHN
Family Centered Care Early and continuous screening Medical home with care coordination Ease of Use of Community-based services Youth Transition to adult health care (think specialty
care too!)
Health care finance
Be a resource to ACOs
www.health.oregon.gov
Public health programs support ACO aims & metrics
Immunizations Flu vaccination Annual well-child visits Annual dental visits Reduced ER usage
Build partnership with ACO to help achieve the 3 aims Remember – there are 3 aims!
www.health.oregon.gov
Opportunities for CYSHN to work with CCOs (ACOs) - An exp a nd ed m od el for sta tew id e ca re coord ina tion Tertiary-based Care Coordination Team
CYSHN are assigned to when they are identified through the hospital or clinics
CC Team serves as single point of contact for families in the targeted group
CC Team nursing, social work, family navigator, psychology – according
to the needs of the child and family Regional Unit of Care Coordination (Senior Nurse Coordinator)
Regionally based senior nurse coordinator (expert nurse with CYSHN) Child/family referred to/through back into community-based care Links family with PCP and community-based care coordination as needed Senior Nurse Coordinator provides connections between the tertiary care
coordinators, PCPs and the community public health services Community-based Care Coordination
Child identified within the community through public health nursing or
primary care settings; goals identified by PHN and/or PCP
Linked to Senior Nurse Consultant for input, and behavioral specialist when
needed
Don Ross, Manager Policy and Program Unit Division of Medical Assistance Programs Oregon Health Authority Donald.ross@state.or.us 503-945-6084
www.health.oregon.gov
Marilyn Hartzell Director, OCCYSHN OCCYSHN / Oregon Center for Children and Youth with Special Health Needs Institute on Development and Disability (IDD) at OHSU Hartzell@ohsu.edu 503-494-6961 Cate Wilcox, Manager Maternal and Child Health Section Public Health Division Oregon Health Authority Cate.S.Wilcox@state.or.us 971-673-0299
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through the chat feature and direct them to the chairperson
Thank you for attending “The ABCs of ACOs for MCH” 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
The recording will be posted on www.amchp.org