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.
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