Overview for Health Plans
We work directly with health insurers, on behalf of pediatrician members, to improve value for the patient and the health insurer. This is achieved through cost control, clinical quality improvement, the medical home, pediatric population management, and practice technologies which enable information management and sharing.
In 2009, CHA launched an asthma care management improvement initiative. By 2012, over 10,500 children with asthma were identified and given care plans and entered into the Pediatric Asthma registry. 2011 Quality Corporation data indicate CHA providers have the lowest ER and hospital admissions compared to other pediatricians and family practitioners and that CHA reduced Emergency Department and Hospital utilization.
Sharing Total Cost of Patient Care in Claims
Through a collaborative partnership with a health plan, total cost of care metrics and Emergency Department (ED) admissions (at the patient level) is shared with providers. This has resulted in a 28% decrease in overall ED costs and 22% decrease in outpatient costs per member per month.
Understanding Child and Family Support Needs
The majority of children are healthy and developing at a normal trajectory. For these children, prevention, early detection with intervention, and timely treatment for illness and injury are most important. A smaller population of children who have chronic conditions, developmental delays or other risk factors, may need additional services such as a shared care plan, more frequent communication to assist in managing care, or coordination of care with specialists, schools or other community resources. Our providers have developed a tool to assess and communicate the level of support needed, by patients and their families, within their care teams. The information from these assessments is aggregated for practice resource planning and service enhancement for the practice’s particular population of patients.
Demonstrated Clinical Quality Improvement
CHA improvement initiatives are approved by the American Board of Pediatrics as Established Quality Improvement Projects. We have a history of provider engagement in grass roots improvement across a network of providers. Our quality initiatives are designed for children. All of our measures are meaningful and actionable at the point of care. We have demonstrated results in all of our quality initiatives.
Two year old immunizations
Since 2008, the overall average CHA rate has increased over 5% with an overall rate of 86.78% at the end of 2011, compared to the Oregon state average of 69%. In 2012, CHA immunization rates increase even further to 88.34%. More than 1,200 patients have been brought up to date as a direct result of this initiative.
Two Year Old Immunization Rate Comparison
Oregon 2011 (by 3 years of age) 65%
National 2011 (by 3 years of age) 69%
CHA 2012 (by 2 years of age) 88%
In January 2012, CHA practices started measuring the number of children at the age of 13 who had received their adolescent immunizations. By June 2012 all practices set two year improvement goals. Practice methods to achieve improvement in their rates include: increased telephone outreach, provider training on methods to overcome resistance to vaccines and offering the vaccines at all visits, not just adolescent well visits. We expect to see significant improvement in adolescent immunization rates by 2014 with these changes.
Asthma Care Management
Since 2009, CHA pediatricians have participated in an initiative to proactively identify and manage patients with asthma. Practices collect and record process measures, based on the 2007 Heart Lung and Blood Institute Asthma management guidelines, into a Pediatric Asthma Registry (provided by the OHSU medical informatics and clinical epidemiology department) to more effectively manage their patients’ condition. Practices experienced dramatic improvements in all the process measures. This experience laid the foundation for the broader management of children with complex medical conditions.
Pediatric Care Management Collaborative
The Pediatric Care Management Improvement Collaborative is a monthly learning collaborative engaging pediatricians, nurses and practice managers from over twenty practice sites. These innovators meet to further develop and deploy education, methods, interventions, competencies, tools and resources to advance the spread of proactive, targeted, office-based pediatric care management. This includes communication and coordination amongst providers and teams involved in the child’s care using the patient assessment tool.
99% of CHA members are a Patient Centered Primary Care Home Tier II or III. CHA initiatives are designed to further develop and support the medical home.
Care for children is inherently family focused and is fostered by long-term patient and family relationships in a medical home. The CHA Parent Advisory Group guides and provides input into our initiatives. Practices are also in the process of adopting standardized family satisfaction surveys.
Other Medical Home Factors
• 24 hour pediatric advice
• Evening and weekend urgent care availability by pediatric providers
• Same day access for injury and illness
Since early 2013, over 25,000 children have been individually assessed in collaboration with their parent during their well child visit for their medical complexity and level of support needed by the practice.The data informs operational decisions to align services and resources to the needs and wishes of children and families. From this data, practices have developed improvement initiatives catered to their population of patients. Some of these include:
• Attention Deficit and Hyper-Activity
• Autism and Development Delay
• Anxiety and depression
EHR, Registries and Population Health Data Integration
CHA practices have Electronic Health Record systems which have some form of integration with CHA asthma and patient assessment registries. CHA is integrating the patient assessment registry with available claims data as a powerful population management tool for practices. All of these systems facilitate population health management, individual patient care management and coordination, test result tracking, appointment tracking, referral tracking, E-prescribing, and data analytic tools for better resource use and service planning. Patient claims data from health insurer fills a critical role in the provider’s understanding of the child’s health. CHA is a trusted intermediary for health insurers to efficiently transfer claims data to providers’ desktops in a format that is actionable at the patient level and informative at the population level.
More Efficient for Health Insurers
Contracting with CHA creates efficiencies for health insurers in contracting, provider relations, quality assurance, and utilization management. CHA can create efficiencies becauses we specialize in children. CHA offers:
• One point of contact for quality improvement, quality measures, payment models, and contract issues
• Fewer negotiations
• Lower communication costs