2% - Association for Community Affiliated Plans ACAP

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Comprehensive Care
Coordination for Pediatric
Populations with
Disabilities
Medicaid and CHIP Payment
and Access Commission
Presentation
November 2012
HSC
Foundation
National
Youth
Transitions
Center
Special
Needs
Consulting
Services,
Inc.
HSC
HealthCare
System
Health
Services
For
Children
with Special
Needs
HSC
Pediatric
Center
HSC Home
Care, LLC
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The HSC Health Care System
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Integrated pediatric and young adult special needs
health care system
Non-profit; 130 years old, 6,000+ served in direct
services; national reach broader
HSCSN-DC only (and out-of-state placements)
HSC Pediatric Center- DC, MD, VA
HSC Home Care-DC, MD
Special Needs Consulting Services- national
National Youth Transitions Center* age 14-26
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Health Services for Children With
Special Needs (HSCSN)
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Care coordination plan for individuals up to age 26
in SSI and related categories via Medicaid CASSIP
A 20 year old program with longitudinal data
Now 5,400+ members/ 60%+ of eligible
Comprehensive coverage with no carve-outs
At risk contract with risk share
District has 14.7% with special needs vs. national
average of 13.5%
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Organization Approach
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Integrated care management incorporating social care
management to help families dealing with disabilities
achieve their highest level of independence
Model includes behavioral, long term care and
recovery model interventions
Network more community and social focused than a
typical MCO
All members receive care management and outreach
Linked to a special needs focused delivery system
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HSCSN Value Equation
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Approach care delivery with granularity; initial home
and family assessment—across continuum
Aggressive family support addressing social
determinants; support groups include Male
Caregivers and others
67% of plan employees have direct engagement roles
with members
Active peer to peer support, engagement with
schools, governmental agencies and NGO’s
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Enrollment By Diagnosis
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Caregivers
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A vital factor for children
Affected by social determinants
79% are biological mothers
10% are grandmothers
1/5 < 30 years of age
Housing is a major barrier
Foster care system is major decision maker for
2% of members
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Major Outcomes
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Better access to Primary and Specialty Care than FFS
47% increase in access to dental services
Cumulative rate increases 55% below commercial
insurance PMPM cost norms from 1996-2009.
From 2003-2008 costs increases were 17% for HSCSN
population compared to 23% in the District and 21%
nationally for all Medicaid SSI.
55% decrease in ICFMR and LTC residential use
50% decrease in use of out-of-state facilities
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Additional Analytic Findings
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2,602 members continuously enrolled during 20082010. Group was 68% of all members and 58% of
incurred medical costs during timeframe.
PMPM for this group increased only 2.5% annually
during 2008-2010
Providers with 35 - 50 patients have highest EPSDT
rates (92% compliance)
Providers with 150 -250 patients have lowest EPSDT
rates (77% to 64%). Equal to very small panels e.g. 1
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Residential Treatment Utilization
7000
6000
5000
4000
3000
2000
RTC Annualized Days/1000 Members:
(Days / MemberMonths x 1000 x 12
months to annualize)
1000
0
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2010 NCQA Quality Compass Results
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National Comparison:
46 out of 90 reported measures
SN exceeded the both the national Medicaid
average and ACAP plan average in 36 measures
or just under 80% of HSCSN’s reported
measures
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Lessons/Recommendations
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Cover social determinant interventions outside of
the pure clinically based realm
Support capacity building to support NGOs in
affecting above re: data, reporting and outcomes
focus [e.g. managed care rigor]
Stimulate development of a “real provider systems
of care” rather than just an “insurance” approach
Use ASO arrangements whenever possible
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Lessons/Recommendations
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Remove risk requirements beyond plan control
Build granular best practices, e.g.
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Hand-offs between medical to behavioral care
Use defined structures to engage family, providers,
schools, NGOs, and government
Define “care coordination” for all stakeholders
Cover entire family and not just the member
Engage individuals with disabilities in solutions
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Contact Information
John Mathewson
Executive Vice President
HSC Foundation
202-454-1236
[email protected]
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