Transforming care delivery in Washington: A focus on children

1. Transforming care delivery in Washington:A focus on children Susan E. Birch, MBA, BSN, RN Director September 22, 2018

2. Today • Who is covered by Apple Health (Medicaid) • Influence of social determinants of health • Role of team-based care • Value-based purchasing to address disparities and determinants • Maternal child health and oral health projects in Accountable Communities of Health

3. Learning Objectives • Through the lens of the Life Stages Model, participants will gain a better understanding of the characteristics and needs of children covered by Medicaid • Participants will learn how the Health Care Authority is using value based purchasing strategies to drive system transformation and improve the health of children • Participants will consider how they as providers can work within their clinics and collaborate with external stakeholders to develop local strategies and support interventions that positively influence the health of children Maternal child health and oral health projects in Accountable Communities of Health • Participants will leave with a better understanding of how Accountable Communities of Health are working with providers to promote the integration of behavioral health care with medical services and improve the health of children across the state

4. Apple Health (Medicaid) by payment plan as of 8/18

5. Apple Health clients by age

6. Apple Health clients by race/ethnicity

7. Apple Health clients by federal poverty level 2018 138% FPL Family of 4: $34,638 https://aspe.hhs.gov/poverty-guidelines

8. Apple Health clients by county

9. Flat trend for numbers of children living in poverty

10. Children living in poverty 2009-2013 https://datacenter.kidscount.org/data/bar/4748-children-in-poverty-by-race-and-ethnicity-state-level?loc=49&loct=2#2/any/false/1376/4684,172,133,12,4100,826,1673,13/11104 <100%FPL

11. Adult health outcomes related to childhood socioeconomic conditions • Cardiovascular disease • Metabolic outcomes • Insulin resistance • Obesity • Type 2 DM • Behavioral outcomes • Alcohol/drug abuse • Depression • Other health outcomes • All cause mortality • Cause specific mortality • Cirrhosis • Smoking • CV disease • DM • Respiratory • Stomach cancer Braverman, P., Barclay, C. Health Disparities Beginning in Childhood: A Life-Course Perspective. Pediatrics Volume 124, Supplement 3, Nov 2009

12. Low birth rate <2500g by race 2016 https://datacenter.kidscount.org/data/bar/9817-low-birth-weight-babies-by-race?loc=49&loct=2#2/49/false/870/4038,4040,4039,2638,2597,1353,4758/19109

13. Adult health outcomes associated with low birth weight • All cause mortality • Cause specific mortality • Cardiovascular • Respiratory • Coronary disease • HTN • Impaired glucose tolerance • Metabolic syndrome • Type 2 DM • Chronic kidney disease • Depression Braverman, P., Barclay, C. Health Disparities Beginning in Childhood: A Life-Course Perspective. Pediatrics Volume 124, Supplement 3, Nov 2009.

14. Social determinants of health

15. http://www.med.uottawa.ca/SIM/data/Models/Healthy_people_2020.JPG">Uottawa.ca</a>http://www.med.uottawa.ca/SIM/data/Models/Healthy_people_2020.JPG">Uottawa.ca</a>

16. Team-based care: evidence suggests outcomes are improved

17. Team-based care Intermountain health care 51K patients over 4 years Reiss-Brennan, B. et.al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA 2016;316(8):826-834

18. Pediatricians are uniquely positioned to address the social determinants of health and the complex environments in which children live

19. The basic science of pediatrics Jack P. Shonkoff et al. Pediatrics 2012;129:e232-e246

20. http://www.lcrn.net/wp-content/uploads/2015/05/LCHD_DiagramPrinciplesv2_PPTuse.pnghttp://www.lcrn.net/wp-content/uploads/2015/05/LCHD_DiagramPrinciplesv2_PPTuse.png

21. State activities to transform the delivery system

22. Payment re-design and value-based purchasing strategies

23. Value-based purchasing https://www.hca.wa.gov/assets/program/vbp-roadmap-2017.pdf

24. State’s VBP standard https://www.hca.wa.gov/assets/program/vbp-roadmap-2017.pdf

26. 2017 measures with 0.75% withhold for managed care plan performance

27. Provide actionable data: Healthier Washington dashboard https://fortress.wa.gov/hca/tableau/t/51/views/HealthierWashingtonDashboard/StatewideMeasureBrowser?:embed=y&:linktarget=_parent

28. Focusing interventions at a regional level

29. Accountable Communities of Health • Promote health equity • Create, support and collaborate on local health improvement plans • Support local and statewide initiatives such as the Medicaid Transformation, practice transformation and value based purchasing • Align resource and activities that improve whole person health and wellness

31. Medicaid transformation projects with a pediatric focus • Reproductive and maternal/child health • Pre-conception health/intentional pregnancies • Evidence-based visiting model for high risk or first time mothers • Evidence-based model or promising practice to improve childhood well child visit and immunization rates • Access to oral health services • Oral health in primary care • Access to mobile

32. Discussion

33. Questions? Sue Birch, director sue.birch@hca.wa.gov Tel: 360-725-2104