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Pediatric Population Health
The Impact on Pediatric Practices
Colorado Children’s Healthcare Access
June 2, 2017
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Presenters
GRETA KLINGLER, MPH
HEALTH SYSTEMS UNIT MANAGER
COLORADO DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
303.692.2408
[email protected]
PAMELA BALLOU-NELSON, RN, MSPH, PHD
SENIOR CONSULTANT
MGMA HEALTH CARE CONSULTING GROUP
630.294.1072 CELL
877.275.6462, EXT. 1877 OFFICE
[email protected]
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Objectives
1. Understanding how payment reform is driving population health.
2. Establish understanding of interdependencies between public health,
population health, population health management and
community pediatrics.
2. Understand how the approach to population health differs in pediatric
setting from population health in adult settings.
3. Review pediatric population health (attribution, empanelment, risk
stratification, data) to promote health outcomes.
4. Share best practices and lessons learned among pediatric practices.
5. Identify opportunities within SIM to improve population health.
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MACRA’s Impact
PAYMENT REFORM DRIVING POPULATION HEALTH
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MACRA’s Impact Payment Reform
• Congress intended MACRA to be a transformative law that
constructs a new, fast-speed highway to transport the
healthcare system from its traditional fee-for-service (FFS)
payment model to new risk-bearing, coordinated care models.
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Impact Payment Reform - Commercial Plans
• 75% of business in value-based payment arrangements by
2020 – Health Transformation Alliance
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Payment Reform in Colorado
Accountable Care Collaborative 2.0
• Shared risk between HCPF and Regional Accountable Entity
• Multiple mechanisms for primary care value-based payment
Alternative Payment Model for Primary Care
• Replacing Enhanced Primary Care Medical Provider Program
• Have pediatric-specific performance measures
• Reimbursement at differential percentages based on provider
selected measures
MACRA is happening in Colorado
• Will be guide for alignment
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Alternative Payment Models
FOR PEDIATRICS
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Alternative Payment Models for Pediatrics
Four key challenges to a pediatric value-based payment model:
• Most children generate little medical expense.
• Children with high medical needs are a heterogeneous population.
• Present and future health status is largely defined by factors not
under the control of clinicians.
• Pediatrics is the foundation of population health. Healthy practices
and prevention will bend the cost curve and improve outcomes over
time, not always a priority for payers.
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Recommendation from Research:
• Payers need to design models that recognize savings from pediatric
care come principally from preventing adult chronic conditions.
• Concurrently, a payment model must also recognize that there are
vulnerable pediatric subpopulations that require higher spending
during childhood for medical services.
• Also, payment models need to address mental health conditions,
prevention and social determinants.
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Recommendation from Research:
• Controlling costs requires the engagement of specialists, as well as a
pediatrician.
• Aligning payment incentives around shared accountability for
outcome and cost.
• Others have advocated for socioeconomic risk adjustment to ensure
adequate payment levels to providers, provision of funding flexibility
and incentives for more direct collaboration with social
service agencies.
• Parent activation measure scores evaluate for behavioral outcomes
impacting wellness and illness.
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Pediatric Alternative Payment Models:
• Capitated Primary Care Payment:
• Covers most child health services
• Care coordination payment
• Risk-adjusted per-patient-per-month payment to fund care
coordination for children within the practice with medical and
social risk factors
• Performance Incentive Bonus
• Total cost of care for those caring for the 1-5% of the pediatric
population with medical complexity
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Current Child Healthcare Value-Based
Payment Models:
• Supplemental Payment and Pay-for-Performance
o Rhode Island
• Episode-based Payments
o Arkansas & Massachusetts
 High-risk Asthma Bundled Payment, which was recently
piloted with 200 patients. The Arkansas bundle covers
inpatient and outpatient costs for 30 days from the trigger
date. Services are paid on a fee-for-service basis with an
opportunity for cost savings if costs come in below the 75th
percentile of costs.
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Current Child Healthcare Value-Based
Payment Models:
• Shared savings on total cost of care
o Ohio
Example: There are a number of pediatric ACOs in the country
that have been formed by children’s hospitals which serve a
considerable number of children covered by Medicaid. Partners
for Kids is an ACO in Columbus, OH, organized by Nationwide
Children’s Hospital. It operates under contracts with Ohio
Medicaid, managed care plans in a large urban and rural region
of the state, and is serving 325,000 Medicaid children through
its ACO as of 2015.
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PEDIATRICS: POPULATION HEALTH
MANAGEMENT
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Population Health Is an Outcome
Population health is defined as the health outcomes of a group of
individuals, including the distribution of such outcomes within the group.
These groups are often geographic populations such as nations or
communities, but can also be other groups such as insurance attributions,
employees, ethnic groups, disabled persons, prisoners, or any other
defined group.
Kindig, DA, Stoddart G. (2003). What is population health? American Journal of Public Health, 93, 366-369.
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Public Health Is a State
Public health is defined as what we as a society do collectively to assure
the conditions in which people can be healthy. (IOM)
Population health protects and improves the health outcomes of an
entire group of people. Population health strategies support
communities affected by disparate opportunities as well as the social
and environmental disadvantaged.
Population Health Management can be defined as how we are
transforming our health systems in ways that benefit entire populations,
rather than focusing on individuals.
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Examples of Pediatric Population Health
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Developmental screening
Early childhood obesity prevention
Vaccination
Adverse Childhood Experiences (ACE) Screening
Maternal mental health
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How to prepare your practice for:
POPULATION HEALTH MANAGEMENT
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How to Prepare Your Practice
• Know your practice:
o Who are my patients?
o What medical conditions do they have?
o Screen for social needs
o What gaps in care and social needs do they have?
o How can I/the community help them fill those gaps?
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How to Prepare Your Practice
• Reconcile your patient’s disease entity
o Claims data and EHR dX data, problem list
• Service reconciliation
o Look at patients and what services visits they should have had
and if it has been done
• Invest in your staff and educate them in Excel and other
applications
• Consider collaborative arrangements with other pediatric
groups/hospital
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SIM Population Health
Population
Health
Workgroup
Provider
Education
Regional
Health
Connectors
Community
Collaboratives
Local Public
Health
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Key Partners
SIM Population Health Work Group
Population
Health Plan
Population
Health
Measures
Advise
Grantees
Identify
Gaps
Community
Strategy
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Behavioral Health Transformation
Collaboratives
Youth
Community
Clinical
Services
Schools
Families
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Local Public Health Agencies
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Local Public Health Agencies
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Regional Health Connectors
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Provider Education
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Collaboration
Coming together is a beginning
Keeping together is progress
Working together is success
- Henry Ford
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Discussion Q&A
Share Best Practices
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