Shared Responsibilities Toolkit Working with Health Plans to Improve Care for Children with Special

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Shared ResponsibilitiesToolkit Working
with Health Plans to Improve Care for Children
with Special Health Care NeedsSusan G.
EpsteinNew England SERVEinfo_at_neserve.org617-574
-9493

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Why Shared Responsibilities?

• Health plans share responsibility for planning,
  paying improving health services for children
  with special health care needs, with other
  partners
• Consumers/Families
• Providers
• State Agencies
• Community-based organizations

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Identify..Collaborate..Improve
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Purpose of Toolkit

• Get attention of health plans
• Identify CSHCN as a population
• Make a business case for investing in quality
  improvement
• Provide range of tools/resources to improve
  systems of care for CSHCN

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Contents of Toolkit

• CSHCN definition
• QI framework emphasizing partnerships
  collaboration
• Tools methods for identifying CSHCN
• Tools for gathering information from
• families, providers, health plans
• Measures of organizational readiness
• Best practice examples

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Introductory Brochure

• WHO are CSHCN?
• WHY identify CSHCN?
• WHY invest in collaboration?
• HOW can health plans improve quality of are?
• WHAT is ROI?

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Who are CSHCN?

• 15 of children
• chronic medical conditions disabilities
• behavioral emotional conditions
• expected to last 12 months or more
• Focus on consequences of a condition, impact on
  functioning need for services

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Why identify CSHCN?

• health plans already serving them
• CSHCN use significant health care resources
• early identification powerful
• predictor of costs
• opportunities for improving outcomes for
  children families
• growing interest by purchasers, policymakers and
  providers

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• Identification Tools
• CSHCN Screener
• developed by the Foundation for Accountability
  (FACCT)
• QuICCC-R
• Clinical Risk Groups
• Administrative data algorithm- NHP

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• Identification Tools
• QuICCC-R developed by Ruth Stein M.D., Laurie
  Bauman Ph.D., Ellen Silver Ph.D.

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• Identification Tools
• Clinical Risk Groups (CRGs) developed by
  National Association of Childrens Hospitals and
  Related Institutions (NACHRI)
• (description))

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• Identification Tools
• Administrative data algorithm- developed by
  Pamela Linov, Neighborhood Health Plan
  (description)

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Why Invest in Collaboration?

• Families are experts
• Providers are best links to patients
• Coordination of benefits
• Tap state Title V resources

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• Collaboration Tools
• Family Survey
• Primary Care Provider
• Survey
• Family Participation
• Statement
• Family Advisor sample job description
• State Title V contacts
• Model for reports to PCPs from health plans

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• Collaboration Tools
• Primary Care Provider
• Survey

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• Collaboration Tools
• Family Participation
• Statement
• Why would families be willing to serve as
  advisors?
• What do families expect from the health plan?
• What do families hope to accomplish by partnering
  in quality improvement?

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• Collaboration Tools
• Family Advisor
• sample job description

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• Collaboration Tools
• State Title V contacts

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• Collaboration Tools
• Model for reporting utilization and cost
  profiles to PCPs from health plans-
• developed by Hood Center for Children and
  Families, Dartmouth- Hitchcock Medical Center

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How Can Health Plans Improve Quality of Care?

• Information for families
• Simplify access to care
• Enhance coordination
• Match resources to needs
• Help families navigate system
• Promote best practices at provider level

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• Improvement
• Tools
• Health Plan
• Checklist
• Organizational
• Readiness Measures
• Best Practice
• Examples
• (4 examples included, will continue to add more)

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Health Plan Checklist

• Detailed list of specific policies and procedures
  that can support quality care
• Identification
• Family Collaboration
• Primary care, specialty care and equipment,
  behavioral health
• Care coordination/case management
• Plan administration and management

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• Improvement
• Tools
• Organizational
• Readiness Measures

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Organizational Readiness Measures

• Assess indicators of internal capacity to improve
  quality care to CSHCN
• Pediatric expertise and leadership
• Importance of childrens health to purchasers
• Capacity to influence care delivery system
• Specific policies and practices (e.g., health
  risk assessments, provider payment)
• Strength of health plans existing external
  collaborations

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Improvement Tools Best Practices

• Growing collection of innovative examples
• Shared Responsibilities Model in
  Action-Neighborhood Health Plan, MA.
• Pediatric Palliative Care- Childrens Hospital
  Regional Medical Center, WA.
• Medical Home Model (PACC Project)- Childrens
  Hospital, MA.
• Consumer Participation in Governance- Childrens
  Choice, MI.

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Next Steps

• Dissemination of Toolkit to Leaders
• Title V programs-CSHCN directors
• Family Voices state coordinators
• MCHB grantees
• Selected health plans
• Tri-Regional Workshops
• Leaders identify partnerships opportunities to
  connect with health plans.

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QUESTION FOR DISCUSSION

• WHAT KINDS OF TECHNICAL ASSISTANCE AND SUPPORT
  DO...
• Title V leaders, family Leaders,
• medicaid leaders and health plans
• need to promote the use of these
• tools for quality improvement?