………………..……………………………………………………………………………………………………………………………………..

The Partners For Kids Journey

OSU HSMP Management InstituteOctober 28, 2016

………………..……………………………………………………………………………………………………………………………………..

Presentation Objectives

• What is Partners For Kids?• Why was Partners For Kids created?• What are Partners For Kids’ goals?• How is Partners For Kids structured?• How does funds flow work?• What have we learned?

………………..……………………………………………………………………………………………………………………………………..

What is Partners For Kids?• Physician-Hospital Organization• Accountable Care Organization (with a

twist)– Member lives attributed to PFK based on the

member’s:• Participation in a managed Medicaid plan• Age• County of residency

– Physician’s contract status with PFK is not a factor

………………..……………………………………………………………………………………………………………………………………..

By The Numbers…• Network

– 100 NCH-employed and 200 community PCP’s– 700 NCH-employed and 50 community specialists– 1 hospital (Nationwide Children’s Hospital)

• Members– 330,000 children

………………..……………………………………………………………………………………………………………………………………..

By The Numbers…• Health Plans

– 5 managed Medicaid plans in Ohio (full-risk capitation, delegated credentialing, delegated care coordination)

– 9 commercial plans (fee-for-service, delegated credentialing)

• Service area– 34 counties

By The Numbers…

………………..……………………………………………………………………………………………………………………………………..

Why Was Partners For Kids Created?

• Managed Medicaid

………………..……………………………………………………………………………………………………………………………………..

Why Was Partners For Kids Created?

0

50

100

150

200

250

300

350

400

1997 1999 2001 2003 2005 2007 2009 2011 2013 2015

Thou

sand

s of M

embe

rsPatient Membership

Contracting Strategy

Managed Care Strategy

Accountable Care Org.(Population Health)

Value Cost

Quality Delivery Safety

Value is Driving New Business Models and Partnership Strategies

Shared Savings /

ACO

Value is Driving New Business Models and Partnership Strategies

P4PFFS

Incentive based FFS

COM PFKFFS

………………..……………………………………………………………………………………………………………………………………..

What Are Partners For Kids’ Goals?

Primary:• Improving the health of children through

high-quality, efficient and innovative care and community partnerships

Secondary:• Demonstrate that a pediatric ACO is viable

model

PFK Population vs. Total PopulationCounty

PFK Members Ages 0-17*

Total 0-17 Population **

% of Total Population =

PFKVINTON 1,764 2,735 64.5%MEIGS 2,791 4,567 61.1%PIKE 3,625 6,003 60.4%SCIOTO 10,195 17,380 58.7%FAYETTE 3,534 6,148 57.5%MARION 7,643 13,694 55.8%JACKSON 3,987 7,347 54.3%HOCKING 3,382 6,243 54.2%JEFFERSON 7,213 13,456 53.6%LAWRENCE 7,338 13,768 53.3%MORGAN 1,471 2,769 53.1%MUSKINGUM 10,957 20,720 52.9%GALLIA 3,843 7,302 52.6%ROSS 8,633 16,662 51.8%CRAWFORD 4,760 9,472 50.3%COSHOCTON 3,735 7,717 48.4%PERRY 4,496 9,395 47.9%FRANKLIN 143,772 302,857 47.5%GUERNSEY 4,266 9,035 47.2%ATHENS 5,372 11,454 46.9%NOBLE 904 1,968 45.9%MONROE 1,310 2,887 45.4%HARRISON 1,430 3,217 44.5%WASHINGTON 5,449 12,365 44.1%BELMONT 5,598 12,745 43.9%MORROW 2,703 6,158 43.9%PICKAWAY 4,584 11,613 39.5%LICKING 13,277 35,606 37.3%KNOX 5,036 13,874 36.3%LOGAN 4,185 11,722 35.7%FAIRFIELD 11,380 32,476 35.0%MADISON 3,649 11,559 31.6%UNION 2,746 10,499 26.2%DELAWARE 5,888 51,635 11.4%

PFK Counties 310,916 707,048 44.0%

PFK Members within County Population

………………..……………………………………………………………………………………………………………………………………..

How Is Partners For Kids Structured?

• Formed as a joint venture (PHO) between Nationwide Children’s Hospital, NCH- employed physicians and contracted, community physicians in 1994

• 501(c)(3) as of January 2016

• The Ohio Department of Insurance considers PFK to be an “intermediary organization” – accepts financial risk, but not a health plan; required to maintain reserves and stop loss coverage

………………..……………………………………………………………………………………………………………………………………..

Governance• Board of Directors comprised of 17 individuals

• 9 appointed by Nationwide Children’s Hospital (including 1 parent of a child enrolled in Medicaid)

• 8 elected from PFK provider network (3 primary care at least one from a community practice; 2 medical specialists, 2 surgical specialist, 1 hospital-based specialty)

Out of Network Providers

Providers Directly Contracted with Payors

PFK Member Community Physicians

NCH and NCH-Employed Physicians

Provider Network and Member Access

………………..……………………………………………………………………………………………………………………………………..

Division of Responsibilities

* Delegated for 3 of 5 health plans

………………..……………………………………………………………………………………………………………………………………..

Partners For Kids Departments

Care Navigation Community Wellness

Data Resource Center

Office of the Medical Director

Operations and Network

DevelopmentPayor Relations

………………..……………………………………………………………………………………………………………………………………..

Flow of FundsPFK receives capitated payments for each child in the program

and pays for their medical costs across the care spectrum

………………..……………………………………………………………………………………………………………………………………..

Pay for PerformanceTop to Bottom Alignment

ODM• State targets measures

Health Plans

• Health Plans incentivized

PFK• PFK engaged in performance based contract

Doctors• Physician incentives on HEDIS and Quality

………………..……………………………………………………………………………………………………………………………………..

Provider Incentive Plan Summary

• Metrics adjusted annually by Incentive Committee (includes provider representation)

• Incentives paid quarterly

• Continues to shift to outcomes-based measures

………………..……………………………………………………………………………………………………………………………………..

Provider Incentive SampleQuality – Health Supervision Visits• Members = 12-18 years old• For patients who were eligible and were non-complaint in the

prior year preceding the qualifying visit

$155.07 persuccessful patient

Quality – Health Supervision Visits• Members = 15 months old• Members = 3-6 years old

$47.86 per successful patient

Pharmacy Shared Savings• For practices which meet or exceed the established

benchmark, receive a portion of the dollars saved through improvements in prescribing patterns

25% (paid semi-annually; paid per practice)

Meeting with Provider Relations Rep to review current year incentive plan by April 30

Must complete to be eligible for any incentive payouts

………………..……………………………………………………………………………………………………………………………………..

• There are advantages in being a provider-based ACO.

What Have We Learned?

What Have We Learned?PFK

LeadershipNCH

Leadership

Director of Care Coordination

PFK Care Coordination

NCH “Global” Care

CoordinationNCH Inpatient

Care Coordination

Quality Initiatives in the NICU

Parent engagement, Feeding

enhancement, and readmissions

Conservative PDA Management and Decreased Ligations

Prevention of necrotizing enterocolitis

Decreased LOS for NAS Patients

Decrease utilization of inhaled nitric oxide

Decreased LOS for

Gastroschisis Patients

IPAC initiative

Complex Care Cohort UtilizationCensus Patient Days per 100 Feeding Tube Patients

Preventing Antibiotic Resistance

………………..……………………………………………………………………………………………………………………………………..

• Accurate, timely and reliable data is essential.

What Have We Learned?

Data Acquisition and Use

………………..……………………………………………………………………………………………………………………………………..

Comparative AnalysisOphthalmic Antihistamines

• Identification: – PFK identified variation in drug utilization by plan

• Intervention– Working with plans to focus on NCH developed guidelines

Medication Relative Cost Plan 1 Utilization

Plan 2 Utilization

Plan 3 Utilization

Ketotifen and its forms

$9-11 6% 3% 81%

Patanol and its forms

$71-130 94% 97% 19%

………………..……………………………………………………………………………………………………………………………………..

• The organization must be prepared to invest in infrastructure – some of which may not have an immediate ROI.

What Have We Learned?

………………..……………………………………………………………………………………………………………………………………..

On-Site QI Training

PROJECT SELECTION AMONG PRACTICES PARTICIPATING IN THE PFK QI/PRACTICE FACILITATION PROGRAM

PracticeProgram

Start Date* Asthma Immunizations

Health Supervision

VisitsAntibiotic

StewardshipFluoride Varnish

ED Avoidance

DepressionScreening

Practice A 8/14/2014 X X

Practice B 8/19/2014 XPractice C 9/5/2014 X X

Practice D 9/17/2014 X X

Practice E 11/12/2014 X X

Practice F 12/11/2014 X X

Practice G 12/11/2014 XPractice H 2/16/2015 X XPractice I 3/12/2015 X XPractice J 4/21/2015 X XPractice K 5/7/2015 X X

Practice L 6/2/2015 X X

Practice M 6/4/2015 X X

Practice N 9/9/2015 X X

Practice O 10/23/2015 X XPractice P 10/28/2015 X XPractice Q 1/27/2016 X X*Date of Feedback Meeting

………………..……………………………………………………………………………………………………………………………………..

• We can effectively manage expenses and lower the rate of expense growth.

What Have We Learned?

………………..……………………………………………………………………………………………………………………………………..

What Have We Learned?

………………..……………………………………………………………………………………………………………………………………..

• There are value propositions for all stakeholders.

What Have We Learned?

………………..……………………………………………………………………………………………………………………………………..

What Have We Learned?

………………..……………………………………………………………………………………………………………………………………..

Questions?

Visit us at www.PartnersForKids.org