Shared Responsibilities Toolkit

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• Shared Responsibilities Toolkit
• Tools for Building Partnerships to Improve
  Health Care Financing for CSHCN
• Susan G. Epstein
• New England SERVE
• AAP Pediatricians Institute
• May 17, 2003
• Chicago, IL

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New England SERVE

• Established in 1983
• Health Policy Network - CSHCN
• Linked to State Title V Programs in NE
• Building Systems of Care
• Defining family centered care
• Quality measures
• Partnerships
• Interagency collaboration

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What do we know about CSHCN?

• Low prevalence
• Multiple systems for care
• Public/Private
• Changing technology
• Chronic heavy users of system
• Shortage of standards benchmarks
• Family centered care

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Impact on Health Care Financing?

• Low prevalencegt
• Multiple systems for care.gt
• Public/Private gt
• Changing technologygt
• Chronic heavy user.gt
• Shortage of standardsgt
• Family centered caregt

• Population based
• Coordination essential
• Public/private collaboration
• Critical need/ interest new info.
• Families providers are experts
• Investments in research
• Family participation in policy

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Why Partnerships?

• Responsibility for building and improving systems
  of care is shared and requires participation from
  multiple stakeholders
• Consumers/families Health plans
• Physicians Other purchasers
• Title V Researchers
• Providers Public policy makers

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In a complex health care system...

• The quality of care for individuals is dependent
  on their knowledge of how to navigate the system,
• and
• The quality of the system of care is dependent on
  its knowledge of the needs and experience of its
  users.

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• What do health plans need to know?

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Identify..Collaborate..Improve
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Shared Responsibilities Toolkit

• Get attention of health plans
• Identify CSHCN as a population (15)
• Make a business case for investing in QI
• Provide tools/resources to improve systems of
  care for CSHCN
• Promote partnerships collaboration
• (Title V, families, physicians, health
  plans)

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Toolkit Contents

• CSHCN definition
• QI framework emphasizing partnerships
• Tools methods for identifying CSHCN
• Tools that support collaboration
• Tools for improving systems of care

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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?

• CSHCN already enrolled
• CSHCN use significant health care resources
• Early ID powerful predictor of costs
• Opportunities for improving outcomes for
• children families
• Interest by purchasers, policymakers and
• providers

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• Identification Tools
• CSHCN Screener
• (Foundation for Accountability)
• QuICCC-R
• (Ruth Stein M.D., Laurie Bauman Ph.D., Ellen
  Silver, Ph.D.)
• Clinical Risk Groups
• (NACHRI)
• Administrative data
• Algorithm
• (NHP)

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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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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 and support best practices at provider
  level

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• Improvement
• Tools
• Health Plan
• Checklist
• Organizational
• Readiness Measures
• Best Practice
• Examples

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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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Challenges

• Everyone lacks experience
• Professional pride
• Silo thinking
• Recruiting supporting families
• Intensity of supports required
• Recruiting supporting physicians
• time

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Outcomes

• New partnerships with Health Plans
• Consortium for CSHCN
• Resource Guide for Families
• Strategies for Identifying CSHCN
• Defining Care Coordination
• New roles for family advisors
• Shared resources
• New investors in CSHCN

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• What can you do?
• Practice
• community
• state

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Practice level

• Gather information
• Identify CSHCN in practice
• Collect office based data
• Learn from families
• Partner with health plans
• Respond to surveys
• Participate in focus groups
• Request information
• Volunteer to serve as advisor

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Community level

• Look for opportunities to educate
• Billing Department
• Hospitals
• Regional business coalitions

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State level

• Join others working for change
• Title V
• Family leaders leadership groups
• AAP state chapter
• State-wide coalitions
• Quality? Access? CSHCN?

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Shared Responsibilities

• For more information
• www.neserve.org
• Susan Epstein
• Director
• New England SERVE
• 101 Tremont Street, Suite 812
• Boston. MA. 02108
• 617-574-9493
• sepstein_at_neserve.org