Need for CHAP Health Net of West Michigan

Pediatric Medical Home “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” American Academy of Pediatrics

The Need for MI-CHAP 40% of Michigan children are currently enrolled in Medicaid – up from 23% in 2001 35% of families with children on Medicaid report having difficulty finding providers who will accept their coverage In 2013, health care reform increased reimbursement for primary care visits from 54% of Medicare rates to 100% of Medicare rates; however, it took almost 18 months for those rates to be funneled to providers. Children on Medicaid in Michigan and Kent County have poorer health outcomes than children with private insurance Low Medicaid reimbursement makes it difficult for practices to accept large numbers of children with public insurance Teaching clinics and FQHCs are overwhelmed by the numbers of Medicaid patients they are asked to see causing more limits to access Costs due to poor preventive care for Medicaid children are significant in terms of ED use and hospitalization rates Michigan children with public or no health insurance have poorer health outcomes than privately insured children, including: Significantly higher hospitalization rates Higher rates of mortality when hospitalized More severe illnesses resulting in hospitalization Significantly higher rates of respiratory illnesses, including asthma More visits to the emergency room Higher readmission rates for newborns after discharge from the hospital

The Need for CHAP If the hospitalization rate for children on Medicaid was the same as for those with private insurance, the estimated savings for one year would be $300-$400 million. Health Net of West Michigan

Social Determinants of Health This slide represents the contributing factors to a person’s health. You’ll notice that Medical Care is only 10% of what makes a person healthy. While we can’t do anything about genetics, we can influence the areas of Environmental Exposure, Social Circumstance and Individual Behavior and this is where the intersection with 2-1-1 is most apparent.

Social Determinants of Health Surveying practicing physicians research shows that… This is where CHAP was born

Social Determinants of Health Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Health Net of West Michigan

Examples of SDoH: Availability of resources to meet daily needs (e.g., safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training Transportation options Public safety Social support Social norms and attitudes (e.g., discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community) Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it) Residential segregation Language/Literacy Health Net of West Michigan

CHAP Program Elements Health Net of West Michigan

Children’s Healthcare Access Program (CHAP) Family, Provider, and System Level Changes: Family: Care Coordination/Navigation of System Patient (parent) education Community Referrals Transportation Provider: TA to improve efficiency & quality Networking System: Increased Access Catalyst for Change Neutral convener

Family, Provider, System Change MI-CHAP is a population-based approach to improving health outcomes, raising the quality of care, and reducing healthcare costs for children on Medicaid. A primary goal is to advocate for SYSTEM-Level Reform Note the three levels within the CHAP model…family, provider and system.

CHAP Provides: Patient Services: Parent education regarding: Appropriate and inappropriate use of emergency department Importance of child’s medical home Importance of well child visits, immunizations, lead screening Referral/ connection to community resources Care coordination Navigation of behavioral/ mental health system Home-based asthma case management/ education Same day/next day transportation to acute care PCP visits Interpretation services

CHAP Provides Practice Services: Assistance in decreasing no-show rates Emergency department use follow-up Assistance with quality improvement projects, such as improving well child, immunization, and lead testing rates, and other HEDIS measures that may result in incentive payments Regular practice-specific data reports including ED/1000 and inpatient/1000 rates, HEDIS measures, asthma measures for CHAP-eligible patients Technical assistance on practice efficiency, scheduling, pediatric triage, throughput, and becoming a family-centered medical home

CHAP Provides: Practice Services (cont.): Education and technical assistance regarding best practices in managing specific health conditions, such as asthma and childhood obesity Opportunities to network and connect with other pediatric providers, via regular practice manager and provider meetings Opportunity to participate in community projects/initiatives if desired

CHAP Team Kent CHAP’s team: A local CHAP team is comprised of staff who have varying expertise. This integrated model provides an approach to our work which allows us to address not only health-related issues but broader issues such as Social Determinants of Health (SDoH). Our interdisciplinary team works collectively to address each client’s barriers and provide a path to health equity. Kent CHAP’s team: 1 - CHAP Manager (LMSW) 2 – LMSW 2 - BSW 1 - Behavioral Health Navigator 5 - CHWs 1 - Practice Engagement Specialist 1 - Program Assistant 2 – Interns (MSW and BSW) Health Net of West Michigan

Kent CHAP Demonstration Project Target population: ~15,000 children ages 0-17 receiving Priority Health Medicaid in Kent County Timeframe: August- December 2008: Ramp up 2009- 2011: 3 Year Demonstration Project 2012: Expansion Pilot Sites Private Pediatric Practices Federally Qualified Health Center- 9 community and school-based clinics Pediatrics Resident Clinic Nurse Practitioner Clinic Total providers: 40 pediatricians and 10-12 FP’s and midlevel providers Health Net of West Michigan

CHAP’s Triple Aim Outcomes

Health Net Case Management http://prezi.com/nnusg09prbeg/?utm_campaign=share&utm_medium=copy Health Net of West Michigan

Case Management Outcomes In 2015, served 2,177 children and 1,279 adults Successful contact rate = 82% 2015 ED Reduction Outcomes (pediatric) 19% reduction in overall ED events 44% reduction in ED events among those referred for “Inappropriate ER Use” 58% reduction in ED events among clients with 6 or more ED visits in one year 2015 ED Reduction Outcomes (adult) 15% reduction in overall ED events Health Net of West Michigan

Selected HEDIS Measure & QI Outcomes 24% improvement in children up to date on 0-15 month well child visits (2012) 3-6 year well child visit rate project (2015) Targeted 145 primarily African American children who had not been seen by PCP Outreach & transportation resulted in 56% up to date PCPs received incentive dollars Health plan met state QI measure Reduction in monthly no-show rate at family practice from 21% [Oct] to 8% [Nov] (2013) Health Net of West Michigan

Special Projects Health Net of West Michigan

ASTHMA Intensive home-based case management (partnership with the Asthma Network of West MI) Education of practices/providers re: best practices in asthma care Development of practice profiles Coordination of all “domains” that asthmatic child comes into contact with (school, community, home, PCP, etc.) Referral to community services (Healthy Homes, etc.) Data collection and outcomes measurement

CHILDHOOD OBESITY Fit Kids 360 Prevention Provider Education Coordination with Healthy Weight Center at Children’s Hospital Collaboration with community stakeholders Advocacy

Oral Health Formation of Kent County Oral Health Coalition Advocacy Improved access to dental services Increased prevention and education Grantee of DentaQuest Foundation Oral Health 2020 Health Net of West Michigan