CHILDRENS HEALTHCARE ACCESS PROGRAM

1
CHILDRENS HEALTHCARE ACCESS PROGRAM Program
Overview
2
NEED

• Children on Medicaid in Michigan and Kent County
  have poorer health outcomes than children with
  private insurance
• Low Medicaid reimbursement makes it difficult for
  practices to accept large numbers of children
  with public insurance
• Teaching clinics and FQHCs are overwhelmed by the
  numbers of Medicaid patients they are asked to
  see causing more limits to access
• Costs due to poor preventive care for Medicaid
  children are significant in terms of ED use and
  hospitalization rates

3
COMMUNITY RESPONSE

• Childrens Healthcare Access Program (CHAP)
• First initiative launched under the auspices of

4
CHAP PARTNERS

• Early Childhood Childrens Commission
• Priority Health
• Helen DeVos Childrens Hospital
• Great Start Collaborative of Kent County
• Spectrum Healths Healthier Communities

5
Data and Outcome Driven

• Phase 1- Research study
• Phase 2- Pilot Program
• Phase 3- Evaluation
• Phase 4- Expansion

6
1 Research Study
Population-Based Hospitalization Outcomes by
Insurance Status for Children in Michigan,
2001-2006
7
1 - Research Study

• Retrospective population analysis
• Children lt18 years old
• Outcomes of publicly insured vs. privately
  insured, newborn population included
• Outcomes
• Publicly insured
• Cost 464 per child higher than privately
  insured
• Total admissions 70 higher
• Asthma admissions 83 higher
• Admits through ED 83 higher
• Newborn readmissions in 28 days 24 higher
• Bronchiolitis admissions 162 higher
• Mortality rates 110 higher
• Overall charges 98 higher
• Total charges in 2006 for publicly insured were
  309-401 million higher

Adjustments of up to 20 allowed due to
fluctuation of Medicaid population
Adjusted rate 271
per publicly insured child
309 million is adjusted amount
8
2 - Pilot Program

• PILOT PROJECT GOALS Triple AIM
• Improve population health outcomes and quality of
  care
• Improve patient experience
• Control costs by lowering ED use and
  hospitalizations

9
2 Pilot ProgramBroad Community Support
Funding

• Early Childhood Childrens Commission
• Frey Foundation
• Steelcase Foundation
• W.K. Kellogg Foundation
• Heart of West Michigan United Way
• Great Start Collaborative of Kent County
• Priority Health
• Spectrum Health
• Helen DeVos Childrens Hospital
• St. Marys Healthcare
• Metro Health Hospital

10
CHAP TEAM

• Medical Director Tom Peterson, MD
• Project Manager Maureen Kirkwood
• Lead Nurse Case Manager Nancy VanHouten
• Lead Resource Coordinator Rebeca Velázquez
• Social Worker Fran West
• Asthma Case Manager Becky Oliver
• 2 Community Health Workers Amelia Lopez
  Sharona Dempsey

11
Participating Provider Commitment

• Acceptance of additional Priority Health Medicaid
  patients
• Active participation in practice manager and
  provider meetings, clinical improvement projects
• Share best practices with other pilot sites
• Commitment to overall project outcomes
• Be transparent with pilot project claims and
  evaluation data
• Go through project-approved processes prior to
  dismissing patients

12
PILOT PROJECT DETAILS

• Target Population
• 14,000 children ages 0-17 receiving Priority
  Health Medicaid in Kent County
• Timeframe
• August 1, 2008 July 31, 2009
• Pilot Sites
• 4 private pediatric practices
• ABC Pediatrics
• Alger Pediatrics
• Forest Hills Pediatrics
• Kent Pediatrics
• 3 Cherry Street Health Services (FQHC)
• DeVos Childrens Clinic (Pediatric Resident
  Clinic)
• 40 pediatricians and 10-12 FPs and extenders

13
PILOT PROJECT STRATEGIES

• System-Level
• Incentive Based
• Enhancing reimbursement to eligible providers for
  acute care office visits, in exchange for being
  open to accepting new Priority Health Medicaid
  patients (capped at a mutually agreed upon
  number)
• Incentive for FQHC
• Practice and Process Improvement
• Expand access hours at local clinics
• Improve phone access system
• Increase productivity (3rd next available and
  patient/hour)
• Improve coordination of behavioral health
  referral system
• Data analysis
• Patient, parent and practice satisfaction surveys
• Evaluation project
• Asthma risk stratification and dashboard
• Monthly reports on ED, immunizations, well
  visits, hospitalization rates

14
PILOT PROJECT STRATEGIES

• Provider-Level
• Medical Management
• Asthma care team standardize asthma care and
  quality measures for CHAP sites, inpatients and
  schools
• Otitis media project 4 sights, anticipatory
  guidance and prescription given at 9 mo check up,
  based on Mayo Clinic study
• Smoking cessation grant - 1 million NIH grant
  with MSU
• Monthly practice manager meetings
• Case management of high utilizers
• Mental health improvement project eliminate
  barriers, improve communication/compliance and
  design new service models
• Sharing Best Practices and Physician Leadership
• Quarterly physician meetings
• Monthly manager meetings
• Asthma care team
• Office sight asthma care profile

15
PILOT PROJECT STRATEGIES

• Family-Level
• Appropriate Resource Utilization
• Nurse case management of
• missed visits
• high utilizers
• inappropriate ED use
• no shows
• Intensive asthma education and case management
• Resource coordination/social work services
• Coordination with existing, underused community
  resources
• Free same-day/next-day transportation
• Assistance with translation services
• Opportunity to participate in Parent Advisory
  Group, other feedback forums

16
3- PROGRAM EVALUATION

• Monthly outcome dashboard reports
• Include
• Utilization measures (ED use, hospitalization
  rates, etc)
• Asthma measures
• Current patient population
• Other quality indicators (immunization rates,
  well visit rates, etc)
• MSU evaluation team providing family and provider
  surveys
• Independent outside evaluator, SRA International,
  hired to conduct three-year process,
  implementation, and outcome evaluation

17
OUTCOME GOALS

• Decrease ED use by 25-30
• Decrease hospitalization by 10
• Increase well child visits at 0-15 months, 3-6
  years and adolescents
• Decrease no show rates
• Improve access to Medicaid patients
• Expand office hours
• Increase same-day access
• Keep after hours phone triage lt20 referral to ED
  
• Provide multiple asthma quality indicators and
  improve asthma care
• Approp med use, asthma action plan use, annual
  PFT, flu shot rates, severity and control
  documentation, high risk, ETS exposure, ED use,
  hospitalization, missed school days,

18
4- POTENTIAL PROGRAM EXPANSION

• Kent County
• All Priority Health Medicaid 0-17
• All Priority Health Medicaid including adults
• Other Medicaid payers
• Participation on ECIC Pediatric Medical Home
  Subcommittee
• Working to develop statewide operational
  definition for pediatric medical home
• Potential development of pilot programs
  throughout the state

19
KEY CHARACTERISTICS FOR SUCCESS

• Based on best practices
• North Carolina and Colorado CCHAP
• Local physician leadership
• Medicaid Managed Care Organization involvement
• Outcome-based/Data driven
• Multidisciplinary team infrastructure
• Community-based collaboration
• Cultural competence and multicultural
  representation at all levels

20
CONTACT INFORMATION

• Tom Peterson, M.D. Medical Director
• tom.peterson_at_spectrum-health.org
• 616-391-7848
• Maureen Kirkwood, Project Manager
• mkirkwood_at_waybetterunitedway.org
• 616-632-1010 (office)
• 616-446-5452 (cell)