Our Vision of Accountable Care
The vision of the Children's Health Alliance is to achieve cost effective quality care coupled with data to inform innovative payment models and benefit designs.
Our focus on quality over the past six years has changed our culture and set the ground work for new possibilities to align quality with reimbursement.
Our providers are working toward a solution which would equip them with meaningful data from claims, integrated with electronic medical record and registry data about their patients at their desktop. This combined with alternative payment models can create sweeping changes in children's care in this region.
The Children's Health Alliance desires to work with select health insurers to develop and test new payment models. We are seeking health insurers who will work with the Children's Health Alliance to build and evolve a pediatric accountable care organization in Southwest Washington and the Willamette Valley.
Characteristics of a pediatric accountable care organization would include or graduate to:
1. Child-specific health care
For families, care for their children is a priority. Families often choose their health plan based upon their relationship with their family caregiver. However, since children are often lower cost, employers and health plans are often indifferent to the unique needs of children. This is an opportunity.
a. Focus on prevention and wellness
b. Keep children on the developmental trajectory
c. Pediatric care management and coordination for needy or high risk patients
d. Pediatric specific measures aligned with other core measures
2. Use of claims data in the practice setting
a. Report outcome measures and evolve toward alternative payment models.
• Child specific considerations, e.g. attribution, measures
• Common attribution method
• Total cost of care (excluding discount)
b. Integrate claims with population management registry
• Assess individual patient utilization patterns to customize care
• Assess aggregated population patterns of utilization and outcome measures
3. Primary care payment models which recognize pediatric non-visit based care and quality improvement activities
a. Budget model with shared savings
b. Blended pmpm care management or PCPCH tier and FFS model
4. Specialty care payment models which encourage coordination and communication
a. Phone consultation reimbursement
b. Shared hospital budget savings
c. Bundled payment
d. Incentives for timely and precise communication during care transitions
5. A system neutral child health care network
a. Providers are aligned for quality, not because of system allegiance
b. A specialty network developed by primary care providers based upon access, communication and cost
c. A collaborative payor-practice care management model
6. A history of collaboration with like partners in systems, communities and local governments
a. Quality initiatives enabled by collaboration with over twenty organizations
b. Local and national presentations about what we've learned
c. Utilize non-profits and public services as additional resources for our patients
d. Innovative three year partnership with a Cordinated Care Organization
7. Patient/family satisfaction
a. Expand the Children's Health Foundation's family focus group for input into accountable care
b. Use the CAHPS or the Child and Adolescent Health Measurement Initiative Medical Home survey across practices for individual, practice and system improvement
c. Consider cost sharing for administration of the survey. Share results. Collaborate on improvements