Children’s of Boston Successfully Partners with Payors in Quality Initiative Program
December 19, 2010
Posted by chcablogadmin in : Community Benefit, Cost Reduction, Quality
By Sandra Fenwick, President and Chief Operating Officer, Children’s Hospital Boston
Sandra Fenwick
As the only freestanding children’s hospital in Massachusetts, Children’s Hospital Boston plays an important role in the health and health care of children in our city, state and region. Since 2006, Massachusetts has taken a lead in health reform through public policy changes and marketplace efforts, and this has impacted the way we conduct our business and prepare for the future. In the long run, the Massachusetts provider community, along with regulatory and payor partners, is challenged to maximize the value we deliver to patients, families and employers by complementing our longstanding commitment to quality with an enhanced emphasis on controlling costs across the care continuum.
One of Children’s primary activities in this regard is the Provider-Payor Quality Initiative (PPQI), a partnership with three major commercial payors and Medicaid, which was launched in December 2009. The hospital and its physicians reduced costs by more than $8o million and returned most of that in reduced rates and prices to insurers in 2010. Additionally, $10 million was earmarked to explore innovative approaches, models, tools and technologies that may improve health outcomes and reduce costs. During the first year of the PPQI, we awarded almost $3.3 million to support a variety of projects aimed at transformative yet sustainable improvement. Projects were presented to the PPQI steering committee, which includes even representation from provider and payor perspectives. The committee provided constructive feedback to project leaders, often informing the approach to evaluating and quantifying efficiency.
Everyone at Children’s believes strongly that efforts like these will improve the lives of our patients and families, and transform health care delivery and financing into to a sustainable,high-value and family-centered system. We stand ready to lead this change and hope all of you will join us in this vitally important fight for the future of child health.
The potential diversity and impact of projects supported by the PPQI is immense and unlimited, given the imaginations of the thousands of faculty and staff who commit their minds and hearts to our patients’ care each day. To date, projects supported by the PPQI have sought to minimize practice variation, foster collaborative clinical management and decisionmaking and develop new family-centered ways to care for complex patients.
Current PPQI projects include:
1. SCAMPs in Cardiology: A Standardized Clinical Assessment and Managements Plan (SCAMP) is a new tool that aims to reduce practice variation, reduce resource utilization, and optimize patient care, even in heterogeneous populations. For a given condition, a SCAMP includes the development of consensus decision trees, tools for data collection tracking the use and outcomes of the consensus approach, and iterative analysis and modification of consensus-based guidelines. PPQI funding is helping develop, implement and evaluate 11 SCAMPs in cardiology.
2. Headache Collaborative Care Model: Working with primary care pediatricians (PCP) from Harvard Vanguard Medical Associates/Atrius, Children’s neurologists are testing a model of care that delivers enhanced assessment of headache in the Medical Home, provides virtual access to neurology advice for headache diagnosis (including imaging decision support) and management; and supports optimal headache management in the primary care setting. This family-centered approach is designed to transform how neurologists and PCPs interact when caring for patients with headache. Participating Medical Home providers and neurologists aim to demonstrate:
a. increased provider satisfaction
b. an improved experience for patients and families
c. equal or improved health outcomes
d. reduced medical expense as a result of fewer imaging studies and shifting the setting for headache management from the sub-specialist’s office to the Medical Home.
3. The Radiology Collaborative Support Model (RCSM): The RCSM aims to improve radiologic pediatric care and optimize resource utilization by developing processes that support appropriate exam selection, performance and interpretation. First, the project team is developing Computerized Physician Order Entry-based decision support (CPOE DS) guidance, including a utility score, to improve exam selection; we expect this to lead to improved patient care and optimized imaging utilization within Children’s. For those needs that are not met by CPOE DS, or in those instances where the ordering provider seeks to override the recommended approach, a pilot Radiologist Consult Service will be established to provide real-time expertise. Based on pilot experience, the Radiologist Consult Service may be expanded to support community-based ordering providers seeking guidance on image selection and to support community-based radiologists in exam performance and interpretation.
4. Chronic Respiratory Technology Adaptor Program: The Adaptor Program is a comprehensive, longitudinal service for children in Massachusetts and greater New England with chronic respiratory insufficiency, technology dependence and related medical complexities. It promotes high quality coordinated care to improve the lives of these children by providing individualized services, including home visits, outpatient clinics and inpatient consultation. Working with this high-need, resource-intensive population, the project team will extend critical care outside the hospital to prevent emergency room visits and inpatient admissions or facilitate early discharge, thereby reducing medical expenses and improving the patient and family experience. Encouraged by findings from a pilot project, support for this program will allow for standardization of the service offering and robust evaluation of the program’s impact.
Everyone at Children’s believes strongly that efforts like these will improve the lives of our patients and families, and transform health care delivery and financing into to a sustainable,high-value and family-centered system. We stand ready to lead this change and hope all of you will join us in this vitally important fight for the future of child health.
add a commentACO Update: Issue #2
December 19, 2010
Posted by chcablogadmin in : Healthcare Reform, Industry Trends, Innovation
Jacqueline Kueser
We hope you enjoyed last month’s premier issue of the ACO Update and found the contents valuable for discussing future plans and strategies with your leadership team. Our goal is to bring you a new perspective from one of our children’s hospitals in each issue as well as a state overview. This time we’ve interviewed representatives from Massachusetts—a state who has been on the frontline and a model of reform for several years, as well as California—a state in financial flux with innovative approaches to reform. You will also find some key information about California’s lessons learned and how two constituency groups, the National Committee for Quality Assurance (NCQA) and several united physician groups, are identifying their role and standards in the development of ACOs.
I welcome your comments and suggestions as well as your questions. Please feel free to contact me directly.
Jacqueline Kueser, Vice President, CHCA
Jacqueline.kueser@chca.com
- What’s happening at Boston Children’s?
- What’s it like at L.A. Children’s?
- Lessons Learned from California ACOs
- NCQAs Proposed ACO Standards
- Physician Groups Issue ACO Principles
You may also access the newsletter (ACO Update_12-20-10) as a document to print and share within your hospital.
add a commentChildren’s Hospitals to Regain 340B Orphan Drug Discounts
December 19, 2010
Posted by chcablogadmin in : Cost Reduction, Group Purchasing, Healthcare Reform
John VanEeckhout, VP, Clinical Services, CHCA
On Weds., Dec. 15 President Obama signed important legislation restoring children’s hospitals’ access to 340B orphan drugs discounts retroactive to January 1, 2010. Although Safety Net Hospitals for Pharmaceutical Access (SNHPA) advocated for extension of the 340B orphan drug discounts to rural hospitals and free-standing oncology hospitals, this was not part of the legislation. (See message below sent from SNHPA 12/9.)
Through the efforts of CHCA, NACHRI, HIGPA, and the Owner Hospitals’ lobbyists and government affairs personnel, we have successfully changed the unfortunate errors from the HCR reconciliation legislation which restricted our access to orphan drugs to full and unrestricted access to all categories of 340B drugs by children’s hospitals.
Thanks for all of your support and hard work on this effort over the past year.
SNHPA Update Special Edition December 9, 2010
SNHPA Applauds Restoration of 340B Orphan Drug Discounts for Children’s Hospitals
Safety Net Hospitals for Pharmaceutical Access (SNHPA) is pleased that Congress today clarified the provision in health care reform that inadvertently denied children’s hospitals access to significant discounts on so-called “orphan drugs” for their patients, many of whom require expensive, long-term or complicated care. The U.S. House passed the legislation this afternoon after the Senate approved it last night. President Obama has indicated that he will sign the bill, H.R. 4994, that includes this technical correction. DONE 12/15.
We thank the members of Congress from both sides of the aisle who advocated for this crucial clarification.
We are also pleased that Pharmaceutical Research and Manufacturers of America (PhRMA), in a statement yesterday, said it did not oppose restoring children’s hospitals’ access to reduced prices on these drugs.
In addition to ending the ban for children’s hospitals, the law that Congress passed today makes clear that such hospitals are entitled to retroactive relief if they were denied discounts.
“While we welcome this development, SNHPA urges Congress to extend these discounts to rural and free-standing cancer hospitals that gained eligibility for 340B under health care reform,” said SNHPA Executive Director Ted Slafsky. “These institutions also spend a significant portion of their drug budget on these therapies. It is imperative that they be able to access affordable medications for their patients.”
Several manufacturers recently began denying 340B pricing on orphan drugs to these institutions and children’s hospitals as well. SNHPA has asked these companies to resume the discounts pending guidance from federal health officials, which we have been told is forthcoming.
We will continue to work with rural and cancer hospitals and our congressional allies to lift the orphan drug ban for these institutions.
add a commentWhat’s Happening at Boston Children’s?
December 19, 2010
Posted by chcablogadmin in : ACO Update
With the Federal Healthcare Reform legislation reportedly having been heavily modeled after that passed by the Massachusetts legislature about two years ago, CHCA ACO Update thought it would be helpful to learn about what is happening at Children’s Hospital Boston. Wendy Warring, Senior Vice President, Network Development and Strategic Partnerships, spoke with us about that. What we learned follows.
State leaders have suggested that they plan to introduce legislation proposing substantial payment reform, and it is likely to be in the form of global or bundled payments. While there has been considerable activity by way of hearings on various aspects of payment reform, no policies have been issued, nor have any specific proposals been passed. The Hospital has, nevertheless, taken on a number of initiatives in anticipation of the move to a more value-based purchasing approach by both the State’s Medicaid program as well as commercial payers, to help further improve the cost and quality effectiveness of programs, and to establish and further enhance relationships with referring physician groups, many of whom have taken on risk based arrangements with private payers. Some of the initiatives are structural/operational and some are strategic.
From an operational standpoint, the Hospital is working with several primary care practices on shared savings projects to lower the cost of care for their patients in risk-based products. The practices with which it is working vary in size and the scope of their connection to the Hospital and its physicians, but the shared savings approach is currently driven most aggressively by practices that have accepted risk on at least 50% of the pediatric populations they serve. There is no shared governance structure in place yet, nor is there joint liability for patient care, but affiliation agreements between the Hospital, its physicians and the practices are targeting defined savings and devising management incentives to complete the projects. Not only is the amount of savings achievable a strong factor in the selection of a shared savings project, but the extent to which the project builds a culture of joint accountability is also weighed heavily. Projects in process and under consideration include those that seek to reduce episode of care costs in connection with conditions such as asthma, scoliosis, lipid control, diabetes and appendicitis. More generally, joint projects will continue to pursue reduced ED demand and utilization, as well as inpatient admissions and readmissions.
Work with primary care practices is also focused on developing joint clinical protocols and processes (collaborative care models) and on enhancing connections with established medical homes to evaluate opportunities to improve population health through more advanced use of information systems and joint proactive outreach to specific populations of children. In the area of developing joint clinical protocols and processes, the Hospital is piloting various initiatives that seek to better target (and reduce) the need for subspecialty support (in neurology, cardiology and imaging, for example). In enhancing connectivity, the Hospital has established various mechanisms for electronically pushing information to its referring providers (discharge summaries, ED encounter information and ambulatory subspecialty visit note) and is providing easier access to clinical data through a provider portal and automated link known as the “magic button.” The Hospital and its physicians have also begun to address the plans of certain community based hospitals to form Accountable Care Organizations that accept substantial risk in their payer relationships. It is in discussions with one regarding management of its pediatric programs under some form of sub-capitation, although this is quite preliminary. Concretely, as a benefit to all referring providers who have accepted risk, as of December 1, the Hospital has moved to differential pricing for its community-based satellites, lowering its prices for radiological and ambulatory surgical services by as much as 20%.
On the Medicaid side, the Hospital is working with several managed care plans to improve care coordination and efficiency of care for their predominantly Medicaid membership; the background is agreement that lowering the cost of caring for Medicaid members is essential to sustainable reductions in rates and prices. Based on shared data analysis, the plans and Hospital are likewise focused on projects that target areas of significant expenditure with feasible alternative care strategies—e.g., the reduction of emergency department visits, including improved management of asthma-related ED visits and the cost of care for high-risk asthma patients. They are also pursuing administrative simplifications to remove these costs. Specific savings targets have been set in association with each project.More strategically, the Hospital is planning, in concert with at least one Medicaid managed care plan, to present the MassHealth (Medicaid) program with options to move fee for service pediatric patients, including high risk patients, into the managed care plans. Not only would this simplify the program administratively, but it will allow the Hospital, its physicians, and the health plans to introduce complex care management protocols that target a segment of the Medicaid pediatric populations with the highest medical expenditures. In accepting the management of some risk, it will also align financial incentives among the health plans, physicians and the Hospital.
The following are among some of the additional structural initiatives that are under way:
- Building a data warehouse – Blue Cross claims data have already been loaded. The Hospital is in the process of loading claims data from other payers and network partners.
- Exploration of methodologies for managing high risk populations.
- Study of and experimentation with bundled payments – The Hospital is evaluating the time and cost involved with craniofacial treatments covering the period from initial assessment to the end of treatment. Further, the Hospital has experience with global payments for care provided to international patients and is evaluating if it is adequately accounting for costs and risks associated with caring for such patients.
- Creation of a team to evaluate innovative payment models.
- Installation of shared savings programs with primary care physicians that incentivize them to redirect care to community hospitals when appropriate (this falls under both the structural/operational and strategic categories).
Editor’s Note: We plan to continue visiting with other hospitals over the coming months to inform you about what they are doing to prepare for and assume leadership in the emerging pay-for-performance environment. Based on all of the initiatives under way at Children’s Hospital Boston, we plan to talk with them again in a few months to learn of and report on what we know will be good progress on the initiatives outlined above.
You may also access the newsletter (ACO Update_12-20-10) as a document to print and share within your hospital.
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