In partnership with 10 of the nation’s leading children’s hospitals, the Children’s Hospital Association received a three-year $23 million Health Care Innovation Award (HCIA) in round two from the Center for Medicare and Medicaid Innovation (CMMI) to test coordinating all resources effectively (CARE) for children with medical complexity, two-thirds of whom are covered by Medicaid.
This project aims to inform sustainable change in health care delivery through new payment models supporting better care, smarter spending and healthier children.
CMS approves carryover funding
The Centers for Medicare & Medicaid Services (CMS) approved a reallocation of unused funds from the previous project year to the final year of the project. This means the more than 50 hospital and primary care based sites can continue their important work in transforming care for more than 8,000 children with complex medical conditions. This funding is critical to support continued data analysis needed for project outcome measurement and a proposed project extension that will allow participating sites to sustain their improvements. View adjusted timeline
Building Data to Manage a Pediatric Population
Details and specifications of a novel data and informatics framework, and lessons learned for sustainability of similar future efforts.
Lessons Learned in the First 18 Months of the CARE Award
Early key findings in this three-year project to test change concepts to improve care and reduce costs for children with medical complexity.
5 ways to Build Primary Care Physician Relationships
Hospitals participating in the CARE award share their insights on developing effective primary care physician relationships.
Implementing Delivery System Transformation
A summary of the progress during the second year of the CARE Award to implement delivery system changes.
CARE Award: Early Lessons Learned
An early look into what delivery system transformation takes.
As we wrap up year three of the award, teams are focused on process implementation to make a measurable difference in care for the patients and families, and achieve results in spending and utilization. This work will position participating children’s hospitals for further sustainability and strengthen the justification to transform care and align Medicaid payment design.
Not yet reporting. Family function/parental stress is one of four metrics contained within the patient experience surveys as an indicator of quality of care during care transformation.
Not yet reporting. Reflects the number of emergency department visits avoided among the enrolled patient population during the implementation of change concepts.
Not yet reporting. Reflects the number of patient days avoided among the enrolled patient population during the implementation of change concepts.
The enrollment goal is set collectively across all sites and is targeted to be achieved by Nov. 2016 to enable attribution of the change concepts to the enrolled population over time.
The patient experience survey is an essential outcome measure of patient/family experience and burden. A baseline survey should be completed once consented and every following six months.
Site Implementing all Five Change Concepts
Have core elements implemented at the prescribed quality level. Improvements in care management are implemented across sites under five key change concepts. Sites apply these concepts to both the complex care clinics and primary care offices. By Nov. 1, 2016, 90 percent of ALL enrolled CARE patients will have dynamic care teams with an average of four of five core elements, access plans with three of three core elements, and care plans with eight of nine core elements.
MCOs provide three-year historical claims data to the Award data vendor, Truven, which standardizes the data to produce utilization and spend analysis of the enrolled population.
Sites work with the actuary vendor, Milliman, to analyze the utilization and spend reports to analyze options for value based payment models.
*Data as of December 2016
This publication was made possible by Grant Number 1C1CMS331335 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.