April ACO Call: Current Integration Efforts at Driscoll Children’s Hospital (Corpus Christi)
July 10, 2011
Posted by chcablogadmin in : ACO Update
Mary Dale Peterson, M.D., MHA, FACHE, President and CEO, Driscoll Children’s Health Plan
Dave Anderson, BDC Advisors
CHCA hosts a monthly conference call series highlighting Owner Hospitals’ movements in the evolving post-reform and ACO marketplace. During the April call, Mary Dale Peterson, M.D., President and CEO, Driscoll Children’s Health Plan, provided an overview of the integration efforts and ACO framework at Driscoll. (Also see “Lessons from 10 Years of Operating a Child-Focused HMO” posted March 6, 2011 in CHCA’s ACO Update). Dave Anderson from BDC Advisors provided context following Mary’s presentation. Attached are the handouts from this conference call and the audio recording.
Overview
Mary Dale Peterson, M.D., is President and CEO of the 60,000 member Driscoll Children’s Health Plan serving both pregnant women and children over a 14 county area. Ten years ago, Driscoll Children’s Hospital created the health plan to assist in providing coverage to children in south Texas.
Dr. Peterson described the current successes and challenges of her endeavors in a recent CHCA conference call:
Mary Dale Peterson, M.D.
Our plan currently emphasizes the integration of cost and quality across the hospital and the health plan. The hospital represents 30 percent of the plan’s costs. The plan works on decreasing utilization. My work with the CEO and CFO of the hospital enables a good understanding of the necessary steps to do so. The plan has reduced utilization by 18 percent over the last three years, but improved all metrics with the hospital. Over the past four to eight years, the plan breaks even and provides revenue to the system.
The primary care physicians practice in a 501(a) entity and are closely aligned with the system. Our relationship building efforts with the physicians are well received. The physicians responded to increased well child visits and decreased ED utilization once incentives were aligned. Eight years ago, with a grant, the plan placed EMRs in physician offices. Now, we are looking to get a health information exchange up and running. Our OBs and PCPs are the core of what we do and I assist them in doing that at all times.
The plan provides prenatal education using lay health workers, dieticians and lactation specialists to improve nutrition, eliminate substance abuse, and understand the signs and symptoms of preterm labor. The plan works with physicians to decrease elective inductions and works with hospitals to implement associated guidelines. We’ve brought on MFM physicians. With 13 percent of pregnant women who are diabetic, the MFMs can do the hand-holding and make the OBs feel more comfortable with waiting until 39 weeks to deliver. Very premature (less than 28 weeks) births are now regionalized to Level 3c NICUs. Our outcomes from these efforts include a 75 percent decrease in traumatic deliveries and a $10 million savings to the state while increasing the number of infants at the children’s hospital. We are focusing on getting families to the best facilities to improve outcomes. We are working with the Vermont Oxford Network dataset to validate our efforts.
Another project focuses on early childhood dental caries. We’ve taught the primary care physicians some basic dental health that includes the application of fluoride varnish to newly erupted baby teeth to decrease the number of children needing dental surgery.
Our efforts include preventing sickness, not just hospital care. We focus on coordination of care. However, we continue to struggle with decreasing payments from the state. We see the answer in increasing quality. The state faces a $27 billion deficit and provider payments are scheduled to decrease by 10 percent. The plan has improved its relationship with the state and saved the state millions while maintaining provider rates through incentive payments and improved prevention efforts to decrease utilization.
The challenge for the system as a whole is to balance the decreased revenue from decreased utilization with more quaternary and tertiary care services that only children’s hospitals can provide. Thus, the system goal is now to increase the health plan presences in south Texas and ensure quaternary cases are covered by the highest quality providers. We’re facing a $20 million shortfall from the state. This is unsustainable. We must prove we are valuable to both the state and the community we serve.
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