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Partners for Kids, one of the nation’s largest pediatric accountable care organizations (ACO), had lower cost growth than did Medicaid fee-for-service and managed care programs in Ohio from 2008 to 2013, without reducing overall quality of care, according to an observational, retrospective study published Feb. 9 in Pediatrics.
Accountable care organizations have been shown to reduce costs for adults without negatively impacting quality of care; however, there’s been little proof before now that the model works for children.
The per-patient/per-month cost increase for Partners for Kids (PFK), which covers more than 300,000 low-income children in central and southeastern Ohio, was $2.40/year from 2008 to 2013, vs. $16.15/year for the Ohio Medicaid fee-for-service program (P = .001) and $6.47/year for Ohio Medicaid managed care programs (almost statistically significant at P = .121).
Results on key quality measures were mixed. Slight improvements were seen over that time in PFK’s gastroenteritis admissions, pediatric acute care, and pediatric composite scores, as well as reduced neonatal ICU admissions and increased well-child visits. However, modest increases were seen in short-term admissions for diabetes and perioperative hemorrhages and hematomas (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-2725]).
Overall, the care differences were a wash; quality measures held fairly steady over the 5 years.
“PFK delivered on the promise of the ACO. ... We suggest that the PFK model achieved these results because pediatric ACOs are better positioned to bridge coordination gaps in care than either an individualized patient-centered medical home or an insurer could do alone; the ACOs are, in effect, the medical neighborhood for the medical home,” said lead author Kelly Kelleher, vice president of health services research at the Research Institute at Nationwide Children’s Hospital and professor of pediatrics at Ohio State University, both in Columbus. “At least for Medicaid, pediatric ACOs may be efficient models of reforming health care. The lower rate of cost growth achieved by PFK bodes well for the short-term success of PFK’s business model and other pediatric ACOs,” said Dr. Kelleher.
Most PFK pediatricians are employees of Nationwide Children’s Hospital. Those who aren’t keep a percentage of their Medicaid fees over cost as an incentive. Also, Ohio’s Medicaid managed care plans pay PFK a monthly capitation fee based on their patients’ age and sex, and PFK keeps whatever they don’t spend on their patients.
The system seemed to work in the study because “PFK is able to provide a single set of provider guidelines for common conditions, a single set of collaborative activities for clinicians, and unified care coordination with pediatric specialty teams. As a physician/hospital organization, PFK is also more directly involved in the specialty care than a typical insurance company and can provide a unified voice on coordination and guidelines,” Dr. Kelleher said.
Having the findings that a Medicaid pediatric ACO improves quality while constraining costs should encourage the more widespread adoption of this model. ACOs may be our best hope to disrupt the current fragmented pediatric health care system to achieve better child health as well as better care.
Pediatric ACOs must show that they can improve quality while constraining costs; restructure health care processes away from traditional physician face-to-face encounters to more effective team models; develop, implement, and evaluate mobile smart phone applications that influence behaviors and promote family/patient understanding; [and] strengthen advocacy efforts to reduce child poverty, which is a root cause of many of our preventable severe child health problems.
Dr. Stephen Berman is a pediatrician at the Children’s Hospital Colorado, in Aurora. His comments come from an editorial accompanying the study. He reported no relevant financial disclosures (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-3739]).
Having the findings that a Medicaid pediatric ACO improves quality while constraining costs should encourage the more widespread adoption of this model. ACOs may be our best hope to disrupt the current fragmented pediatric health care system to achieve better child health as well as better care.
Pediatric ACOs must show that they can improve quality while constraining costs; restructure health care processes away from traditional physician face-to-face encounters to more effective team models; develop, implement, and evaluate mobile smart phone applications that influence behaviors and promote family/patient understanding; [and] strengthen advocacy efforts to reduce child poverty, which is a root cause of many of our preventable severe child health problems.
Dr. Stephen Berman is a pediatrician at the Children’s Hospital Colorado, in Aurora. His comments come from an editorial accompanying the study. He reported no relevant financial disclosures (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-3739]).
Having the findings that a Medicaid pediatric ACO improves quality while constraining costs should encourage the more widespread adoption of this model. ACOs may be our best hope to disrupt the current fragmented pediatric health care system to achieve better child health as well as better care.
Pediatric ACOs must show that they can improve quality while constraining costs; restructure health care processes away from traditional physician face-to-face encounters to more effective team models; develop, implement, and evaluate mobile smart phone applications that influence behaviors and promote family/patient understanding; [and] strengthen advocacy efforts to reduce child poverty, which is a root cause of many of our preventable severe child health problems.
Dr. Stephen Berman is a pediatrician at the Children’s Hospital Colorado, in Aurora. His comments come from an editorial accompanying the study. He reported no relevant financial disclosures (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-3739]).
Partners for Kids, one of the nation’s largest pediatric accountable care organizations (ACO), had lower cost growth than did Medicaid fee-for-service and managed care programs in Ohio from 2008 to 2013, without reducing overall quality of care, according to an observational, retrospective study published Feb. 9 in Pediatrics.
Accountable care organizations have been shown to reduce costs for adults without negatively impacting quality of care; however, there’s been little proof before now that the model works for children.
The per-patient/per-month cost increase for Partners for Kids (PFK), which covers more than 300,000 low-income children in central and southeastern Ohio, was $2.40/year from 2008 to 2013, vs. $16.15/year for the Ohio Medicaid fee-for-service program (P = .001) and $6.47/year for Ohio Medicaid managed care programs (almost statistically significant at P = .121).
Results on key quality measures were mixed. Slight improvements were seen over that time in PFK’s gastroenteritis admissions, pediatric acute care, and pediatric composite scores, as well as reduced neonatal ICU admissions and increased well-child visits. However, modest increases were seen in short-term admissions for diabetes and perioperative hemorrhages and hematomas (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-2725]).
Overall, the care differences were a wash; quality measures held fairly steady over the 5 years.
“PFK delivered on the promise of the ACO. ... We suggest that the PFK model achieved these results because pediatric ACOs are better positioned to bridge coordination gaps in care than either an individualized patient-centered medical home or an insurer could do alone; the ACOs are, in effect, the medical neighborhood for the medical home,” said lead author Kelly Kelleher, vice president of health services research at the Research Institute at Nationwide Children’s Hospital and professor of pediatrics at Ohio State University, both in Columbus. “At least for Medicaid, pediatric ACOs may be efficient models of reforming health care. The lower rate of cost growth achieved by PFK bodes well for the short-term success of PFK’s business model and other pediatric ACOs,” said Dr. Kelleher.
Most PFK pediatricians are employees of Nationwide Children’s Hospital. Those who aren’t keep a percentage of their Medicaid fees over cost as an incentive. Also, Ohio’s Medicaid managed care plans pay PFK a monthly capitation fee based on their patients’ age and sex, and PFK keeps whatever they don’t spend on their patients.
The system seemed to work in the study because “PFK is able to provide a single set of provider guidelines for common conditions, a single set of collaborative activities for clinicians, and unified care coordination with pediatric specialty teams. As a physician/hospital organization, PFK is also more directly involved in the specialty care than a typical insurance company and can provide a unified voice on coordination and guidelines,” Dr. Kelleher said.
Partners for Kids, one of the nation’s largest pediatric accountable care organizations (ACO), had lower cost growth than did Medicaid fee-for-service and managed care programs in Ohio from 2008 to 2013, without reducing overall quality of care, according to an observational, retrospective study published Feb. 9 in Pediatrics.
Accountable care organizations have been shown to reduce costs for adults without negatively impacting quality of care; however, there’s been little proof before now that the model works for children.
The per-patient/per-month cost increase for Partners for Kids (PFK), which covers more than 300,000 low-income children in central and southeastern Ohio, was $2.40/year from 2008 to 2013, vs. $16.15/year for the Ohio Medicaid fee-for-service program (P = .001) and $6.47/year for Ohio Medicaid managed care programs (almost statistically significant at P = .121).
Results on key quality measures were mixed. Slight improvements were seen over that time in PFK’s gastroenteritis admissions, pediatric acute care, and pediatric composite scores, as well as reduced neonatal ICU admissions and increased well-child visits. However, modest increases were seen in short-term admissions for diabetes and perioperative hemorrhages and hematomas (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-2725]).
Overall, the care differences were a wash; quality measures held fairly steady over the 5 years.
“PFK delivered on the promise of the ACO. ... We suggest that the PFK model achieved these results because pediatric ACOs are better positioned to bridge coordination gaps in care than either an individualized patient-centered medical home or an insurer could do alone; the ACOs are, in effect, the medical neighborhood for the medical home,” said lead author Kelly Kelleher, vice president of health services research at the Research Institute at Nationwide Children’s Hospital and professor of pediatrics at Ohio State University, both in Columbus. “At least for Medicaid, pediatric ACOs may be efficient models of reforming health care. The lower rate of cost growth achieved by PFK bodes well for the short-term success of PFK’s business model and other pediatric ACOs,” said Dr. Kelleher.
Most PFK pediatricians are employees of Nationwide Children’s Hospital. Those who aren’t keep a percentage of their Medicaid fees over cost as an incentive. Also, Ohio’s Medicaid managed care plans pay PFK a monthly capitation fee based on their patients’ age and sex, and PFK keeps whatever they don’t spend on their patients.
The system seemed to work in the study because “PFK is able to provide a single set of provider guidelines for common conditions, a single set of collaborative activities for clinicians, and unified care coordination with pediatric specialty teams. As a physician/hospital organization, PFK is also more directly involved in the specialty care than a typical insurance company and can provide a unified voice on coordination and guidelines,” Dr. Kelleher said.
FROM PEDIATRICS
Key clinical point: Pediatric ACOs can conserve health care funds while providing quality care.
Major finding: The per-patient/per-month cost increase for Partners for Kids was $2.40/year from 2008 to 2013, vs. $16.15/year for the state’s Medicaid fee-for-service program and $6.47/year for the state’s Medicaid managed care programs.
Data source: Observational, retrospective study from one of the nation’s largest pediatric ACOs.
Disclosures: Dr. Kelleher serves on the board of Partners for Kids (uncompensated). Coauthor Pam Carr, R.N., is the ACO’s executive director. The study was funded in part by the Centers for Medicare & Medicaid Services.
