paying for care coordination
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Paying for Care Coordination. Deborah Allen, ScD Boston University School of Public Health Josie Thomas Parent’s Place of Maryland. State-at-a-Glance Chartbook The Catalyst Center. Educational and inspirational tool for state policymakers and other stakeholders - PowerPoint PPT PresentationTRANSCRIPT
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Paying for Care Coordination
Deborah Allen, ScDBoston University School of Public Health
Josie ThomasParent’s Place of Maryland
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State-at-a-Glance Chartbook The Catalyst Center
• Educational and inspirational tool for state policymakers and other stakeholders
– Key indicators of health care coverage for children and youth with special health care needs by state
– Descriptions of promising practices in improving coverage and financing
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Meg Comeau, MHADirector
The Catalyst CenterHealth and Disability Working Group
Boston University School of Public Health
617-426-4447, ext. [email protected]
www.hdwg.org/catalyst
For more information, contact
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Paying for Care Coordination
Why it matters
Strategic approach
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Why it matters• To Families
– Consistent findings that families place a high priority on care coordination– Consistent findings that there is unmet need in this area
• To State Title V Program Staff– Reflects Title V expertise– Reflects Title V philosophy/systems approach– Links public health to direct care and families
• To Providers– Central to medical home model – Most expensive component of medical home and thus, hardest to assure
• In relation to national 2010/New Freedom agenda– May be most direct, concrete manifestation of family-centered, comprehensive, coordinated
care– Key test of system success
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Starting assumptions --before you get to what it costs
• Children with special health care needs are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally
• Any child or youth with special health care needs may need access to care coordination at some time
• An organized, statewide system of care coordination is the only way to assure universal access
• The medical home is the best option for a statewide system of care coordination
• Care coordinators in the medical home• Can serve children and adolescents with a range of disabilities or
chronic conditions effectively• Can serve children and adolescents with a range of disabilities or
chronic conditions efficiently
*See Chapel Hill Pediatrics presentation at http://www.medicalhomeinfo.org/model/MHLC.html
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What have we learned from states
• No state has achieved universal access to medical home care coordination yet– There may not be a single, universal formula for
success
• But there has been enough progress to offer lessons related to two strategic objectives
1. Bring down the cost
2. Get partners to share the cost
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Estimating the cost of care coordination
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Why conduct the exercise
• Highlights key components of a system
• Drives debate within the field about optimal approach to system
• Makes statewide implementation a real possibility for policy makers
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Relevant variables
• The number of children with special health care needs in the state– Depends on population and percent CSHCN
• The caseload per FTE medical home care coordinator per year– Depends on model
• The salary per FTE care coordinator per year– Depends on model and local labor market
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Case example: Washington
• 2000 Census: 1,513,843 under age 18• National CSHCN Survey: 13.7% reported to
have special health care needs• That means 207,396 children with special
health care needs• For purposes of estimation: 200,000 CSHCN
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The caseload per FTE care coordinator
• Depends on model and case mix• For purposes of estimation:
– Washington has 500 pediatricians; about 250 family practitioners see children
->Average primary care caseload is 1.5mil/750=2,000
– If assume 1 FTE care coordinator serves typical panel of 2,000
->Each care coordinator serves about 275 CSHCN
->System requires 750 care coordinators
– If assume 1 FTE care coordinator can actually serve 600 children and that a care coordinator can work with more than one provider
-> System requires 375 care coordinators
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So let’s roughly estimate
• 375 FTE care coordinators
• Distributed among 750 FTE physicians
• Each caring for about 530 children
• To serve the state’s population of 200,000 CYSHCN
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Washington labor market salaries
For nurse manager $37.75*
For staff nurse $30.54
For health educator $24.22
For medical/public health social
worker $23.45
For child and family social worker $17.62
For trained paraprofessional $14.67
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Annual salary
• At hourly rate of $35 $72,800
• At hourly rate of $25 $52,000
• At hourly rate of $15 $31,200
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System costs for 375 care coordinators with benefits
@ .25• Advanced practice RN $34,125,000• Social worker $24,375,000• Certified paraprofessional $14,625,000
• Plus Estimate $2,000,000 in system oversight cost\
• -> Cost is between $16 and $36 million
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How are costs spread across system
• Cost of care coordination for CYSHCN per CYSHCN
• Range is $80 to $180/year
• Cost of care coordination for CYSHCN per child• Range is $11 to $24/year
• 24% of Washington CYSHCN are enrolled in Medicaid
• Assume FFP covers ½ of 24% of total cost • State cost would be reduced by $2-$4 million
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Does care coordination produce savings?
Compare costs of care coordination to family costs– 12% of Washington families of CYSHCN exceed $1,000/year out
of pocket– Assume each of those families spends exactly $1,000/year– Then those families ALONE spend $24 million/year
Possible sources of savings due to care coordination– Inpatient care
• Number of hospitalizations or LO• Cost of hospitalization/CSHCN almost four times cost/child
nationally– Specialty visits
• Cost for physician services for CSHCN more than two times cost/child nationally
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Sources for estimating cost of statewide care coordination
• Census http://www.census.gov/prod/2006pubs/07statab/pop.pdf
• Percent CSHCN http://cshcndata.org/Content/States.aspx
• Salary per care coordinator http://www.bls.gov/oes/current/oessrcst.htm
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The Catalyst Center on Financing and Coverage for CYSHCN
• Our priorities– Medical debt among families of CYSHCN– Cover more kids through Medicaid buy-in– Reduce gaps through Catastrophic Relief– Enhance quality through financing of care
coordination
• Our team– Carol Tobias, Susan Epstein, Sally Bachman, Meg
Comeau, Deborah Allen– Find us at http://www.bu.edu/hdwg/– Contact me at [email protected]