A Year in Review
January 9, 2011
Posted by chcablogadmin in : Blogs & Social Media
Each new year brings retrospection as well as an energized optimism of what’s ahead. This goal of this blog is to bring you fresh perspectives from your CEO colleagues and their hospitals as well as CHCA news. We wanted to bring you the top five First Round blog entries over the past 12 months or so and ask for your input going forward:
- By far, our most widely read blog was Alan Goldbloom’s “Canadian Perspective on Children’s Health Care.” Even after health care reform passed the debate and legal wrangling still make this article relevant today.
- Chris Dawes shared important CPOE findings in “Moving the Big Dot – Mortality Trends at LPCH.”
- Ben Melson candidly shared strategy in “Texas Children’s Shares Financial Successes from Goldman Sachs Report.”
- Roch Parayre, Ph.D., from Decision Strategies International provided “Three Must-Do’s for Children’s Hospital CEOs.”
- The new ACO Update is also in the top five viewed pages of the year.
We’re open to your ideas on content, topics and individuals you’d like to learn more about. Can you share your biggest successes, failures, surprises and challenges? The success our children’s hospitals and CHCA has relied on the transparent sharing of knowledge, ideas and strategies and we will continue in the same vein. — JR
add a comment2010 CHCA Customer Satisfaction Survey Results Highest in 3 Years
January 9, 2011
Posted by chcablogadmin in : CHCA News
We are pleased to report that our CHCA Customer Satisfaction Survey results for 2010 depict the highest ratings in three years (CHCA Annual Cust Sat Survey 2010). In addition, there was substantial movement from “neutral” and “satisfied” categories to “very satisfied.” Here are some specific results:
- In 2010, 96% (349) of respondents indicated they are satisfied with the information they receive through CHCA and it is helpful to their work. There was a 7% increase from 2009 to 2010 in those who are “very satisfied.” (Results were 94% in 2009 and 2008.)
- Ninety-two percent (335) of all respondents are satisfied with the accessibility of information through CHCA in 2010. (Results were 89% in 2009; 90% in 2008.)
- In 2010, 90% (331) of respondents reported satisfaction with unique information provided by CHCA. This is an increase of 4% from 2009 with a gain of 8% responding “very satisfied.”
- Respondents indicate they are 93% (342) satisfied in 2010 with the value they receive from CHCA provided programs/services, up from 92% in 2009. There was also a gain of 9% in the “very satisfied” category.
Attached are the verbatim responses to the question, “What should your hospital CEO know about your CHCA experience?” If you would like a copy of the complete verbatim comments, please contact Nancy Vasto (nancy.vasto@chca.com).
add a commentMaking the ACO Concept Work — Nationwide Children’s Hospital Medicaid Managed Care Experience
January 9, 2011
Posted by chcablogadmin in : ACO Update
Steve Allen, M.D.
Hospitals wading into Accountable Care Organization (ACO) waters might feel more comfortable with their next move after learning about Nationwide Children’s Hospital’s (Columbus, OH) Partners for Kids (PFK) program. CHCA ACO Update recently interviewed Dr. Steve Allen, CEO, and Tim Robinson, CFO. We heard a very exciting story about the resulting favorable impacts on participating children and their families, community hospitals with which PFK works, and the hospital’s bottom line. Here is what we learned.
Tim Robinson
Nationwide Children’s launched its PFK program in response to a State of Ohio initiative in 1994. PFK is a non-profit, tax paying entity owned 50% by Nationwide Children’s and 50% by its affiliated physicians (350 primary care and 410 specialists, most of whom are hospital employees). PFK contracts with three of the eight state-designated regional Medicaid health plans and is fully at risk for the cost of health care services for approximately 290,000 children. The Medicaid managed care plans are each capitated based on an age- and sex-adjusted formula. For those children in the PFK service area, the health plans pass along that capitation to PFK and PFK pays the hospital and its affiliated physicians a sub-capitated rate (i.e., a fixed amount per member per month). Community physicians with agreements with PFK are paid on a fee-for-service basis at slightly above normal Medicaid fee-for-service rates; non-affiliated physicians and other providers not contracted with PFK are paid fee-for-service at rates negotiated by the health plans based upon some percentage of the Medicaid fee schedule. Pharmacy services, which used to be included in the sub-capitated rate, but are no longer, are paid for separately by the state on a fee-for-service basis. The state removed pharmacy from the capitated program to take advantage of pharmaceutical rebates for which states may qualify.
PFK is ultimately at risk for achieving a given medical loss ratio for the children included in the program and assigned to PFK (the geography now includes 37 counties). Payments made by the managed care plans for care provided to patients assigned to PFK by providers other than those associated with PFK are deducted from the overall capitation amount to indicate what is due PFK. Besides distributing capitation payments to its own physicians, PFK is responsible for network development, PFK member physician contracting, clinical management, data management and analytics. It shares responsibility with the managed care plans with which it contracts for quality management, case management, 24-hour nurse advice, and improvement initiatives in the areas of wellness, expanding access and improving efficiencies.
The managed care plans’ roles include marketing, utilization management, case management, physician contracting (for non-PFK member physicians and other providers), enrollment eligibility verification, member services (grievance resolution, member inquiries, PCP assignment, issuance of ID cards), health education, preventive care reminders, transportation, claims payment and data sharing.
While the Federal Government hasn’t issued detailed guidelines yet for becoming an ACO, the Patient Protection and Affordable Care Act (PPACA) contains some basic criteria ACOs will be required to meet. PFK believes it meets all except for the ability to exchange clinical information across care settings, including those of unaffiliated providers. And PFK is just starting to implement evidence-based clinical guidelines at the point of care, which is also a criterion contained in the PPACA–initially for an ADHD Collaborative with asthma due up next.
PFK employs nine FTEs and receives additional assistance from the hospital’s HR, finance, data support and IT resources. It contracts out data warehouse, data repository, web reporting, and HEDIS reporting functions to a single vendor. Claims data management is the largest full-time job for PFK staff resources. PFK also provides outreach and helps patients navigate the delivery system. PFK attempts to control utilization and expenses for care provided its assigned patients by providers not included under PFK’s sub-capitation. PFK has set contractual parameters for use by the managed care plans in their provider contracting efforts and receives and reviews all claims data to ensure that contracts are in line with the parameters and that the managed care plans are paying the providers appropriately (this includes for pharmacy). PFK also monitors if there are quality improvement or savings opportunities associated with pharmacy usage as well.
PFK is proud to have achieved and spearheaded a number of initiatives promoting wellness, reducing expense, and making care more effective and convenient for patients and their families. They took advantage of their knowledge that many of the levers for managing care for kids are different from those useful in managing adults’ care. They also recognized that socio-economic issues are often a major factor in reducing expense or impacting care quality and availability for their assigned population. The following are among some of those initiatives:
- Near-term scheduled birth rate reduction – Working with community and its own physicians, PFK was able to reduce near-term births from 14% of the covered population to under 10% between January 2007 and July 2010. Near-term births have been associated with health problems later in life.
- Lowered Neonatal Intensive Care Unit (NICU) days from about 175/1000 covered children in 2009 to about 100/1000 by spring, 2010 – a 43% reduction. Part of this was accomplished by using a Federal Grant and the state’s fiber optics network to set up a telemedicine program in hospital nurseries up to one hundred miles away. The program is used for capitated and non-capitated patients alike. Nationwide Children’s neonatologists have teleconferences with the patient’s attending physician. Transfers have been cut in half.
- Increased influenza immunization rates – Focusing on PFK’s affiliated six specialty clinics, PFK was able to increase the percentage of immunized children from 50% in 2008 to about 80% in 2009. A key insight was identifying that travel to immunization sites was an issue. As part of the solution PFK was instrumental in the provision of tokens beneficiaries could use to pay for transportation. The immunization rate for the assigned population is now about double that for the US and is more than double the rate for the rest of Ohio.
- Through work with the Ohio Children’s Hospital Association, reduced surgical site infection rates by 50% and adverse drug events by 33% – This equated to over $3.08 million in savings in just ten months.
- Focus on reducing premature births – Recognizing that prematurity consumes lots of resources, including unnecessary NICU days, PFK spearheaded a citywide collaborative with hospitals that provide birthing services (Nationwide Children’s does not do so) to reduce prematurity in Franklin County. The county provided $7 million which is being used to identify high risk women, make it easy for pregnant mothers to get to prenatal clinics and to have appointment times available, enable hormone injections during the second trimester for those who previously had premature births, establish and operate an education program for mothers to space pregnancies at least 24 months apart, and to create the Nurse-Family Partnership to work with high risk, first-time mothers via home visits throughout the pregnancy and for 18-24 months after the birth.
Besides providing both the impetus and, in many ways, the wherewithal to pay for or justify the expense of designing and installing initiatives that have improved care and reduced expense, the hospital is relatively pleased with how the program has worked for them and their affiliated physicians financially. They view that the program has helped them reduce the Medicaid shortfall and enabled them and their affiliates together to outperform traditional Medicaid financially. They also think that the program has helped position them to handle expected additional Medicaid tightening.
So, what is coming next? At this time, no one knows with respect to changes the state might make. The newly elected governor faces a $6-8 billion budget shortfall that may impact Medicaid funding. PFK will be moving to a pay-for-performance arrangement, versus the supplemental payment historically provided for expanded access, with those participating physicians currently paid on a fee-for-service basis based on meeting certain quality measures. It hopes to get pharmacy included again under the capitated program. The state program in which PFK participates currently excludes those covered under the Aged, Blind, or Disabled Program, and, if the numbers actually make sense for doing so, PFK would like to have such patients included in the managed care program. PFK believes it can manage the care for such patients better than the health plans or the state (it already is doing so for a number of high risk patients who are included in the program in which PFK participates). PFK also plans to further develop and implement additional guidelines for care based on evidence-based protocols.
Among the other hoped-for or planned initiatives are improvements in the availability and use of data and expanding the use of sub-capitation among specialists. Good data are key, and efforts must be constant to ensure the data are not only good but also used effectively. Right now PFK uses claims data. The plan is to integrate those data with clinical information. While many specialists are paid based on capitation, the plan is to include more under sub-capitation.
With regard to expanding to include commercially covered lives, Nationwide Children’s is taking a “wait and see” attitude. No single commercial payer seems to have a large enough base of patients to justify moving forward with the same or a similar program. Regarding the potential issue of adult-oriented ACOs siphoning off primary care physicians and non-Nationwide Children’s-affiliated pediatricians (both primary care and specialists), Nationwide Children’s hasn’t seen much ACO activity so far in its service area and is somewhat protected by virtue of operating and providing physician staffing at the two non-academic adult hospital NICUs in its primary service area. Its large base of current arrangements with many of those physicians is an additional plus.
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