Identifying Complex Needs in a Pediatric Population – Part 2 Britta Fuglevand, MSHA - RMHP December 14, 2018 Section - Title

What is Risk Stratification? “Risk stratification is an intentional, planned and proactive process carried out at the practice level to effectively target clinic services to patients.” Asaf Bitton, MD, MPH, FACP, Center for Primary Care at Harvard Medical School Section - Title

Why is Risk Stratification Important? Right service Right Patient Right Time Reduce waste Reduce chaos Improve outcomes Do you ever feel like you don’t have enough resources to help all of your patients who need it? Section - Title

How is Pediatrics different? Source: Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality. April 2014. Section - Title

Continued This just demonstrates what we already klno Source: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2016 National Health Interview Survey. National Center for Health Statistics. 2018. Section - Title

How is Pediatrics the Same? Resources and support are still needed Resources, especially time, are limited Patients and families do not always get the support they need Section - Title

Change in perspective We need to change our point of view on the factors for pediatric risk stratification They should make sense for your population Credit to Sadie Hernandez, https://www.flickr.com/photos/sadiediane/4884006357 Section - Title

How to Develop Risk Stratification Section - Title

Developing a Useful Stratification Who? Who are you trying to identify? What is your population of focus? Key Components What are some key components that define that population? Data Elements What are the data elements that describe that key component? Reporting How can you easily report on that data element? Section - Title

Example – Preventative Focus Who? Who are you trying to identify? Patients that may have preventable, negative health outcomes in the future Key Components What are some key components that define that population? Adverse Childhood Events Social Determinants of Health Healthy Weight, good physical activity and nutrition habits Data Elements What are the data elements that describe that key component? ACEs Score Family Poverty, Food Insecurity, etc. BMI %ile, # of sugar sweetened beverages in last 2 weeks, etc. Reporting How can you easily report on that data element? Patients with positive ACE score Report on Insurance type Report on patients with BMI%ile increasing in last year Section - Title

Evaluation ? What “risk” are you trying to identify? What should your/this tool predict? How will you know if your tool captures the right populations? Can you easily measure the elements you want to include in your stratification? If not, how will you include them in your stratification? What is missing from your tool? Will it help your providers? Will it help your patients? Will it help your staff? Section - Title

Practice Examples – Risk Stratification Section - Title

Risk Stratification for the Whole Patient CMS concluded after a pilot of 500 clinics (CPCi): Objective elements Subjective elements (Clinical Intuition) Must have a: Two Step Risk Stratification Tool Section - Title

Mercy Pediatric Risk Stratification Tool Section - Title

“We want to identify the patients we can impact” Western Colorado Pediatric Associates Section - Title

Your Turn Section - Title

Brainstorming Discuss at your table: What is your population of focus? What are some key components that define that population? How will you know your tool identifies the right people? Section - Title

Group Discussion What are some key components you picked? What do you like about your current risk stratification process? What is a challenge? Other questions? Section - Title

The Process Section - Title

What is your process for scoring patients? Implementation – What is your process for scoring patients? How will everyone know what the patient’s risk score is? What’s the workflow for updating patient scores? Your goal for stratification should drive your implementation strategy – run report for the entire population? Score a few patients each day? Consider what happens after scoring – will care management be flooded? How will everyone know what the patient’s risk score is? Where is the score noted? Can it be reported? Workflow for updating patient scores Annually? At each visit? Section - Title

Does everyone know why you’re doing risk stratification? The Big Picture Does everyone know why you’re doing risk stratification? Upstream Effects: How to get good data How will you pull reports Consistency between providers and locations Downstream effects: Care Management Strategy Reporting for programs Section - Title

Questions? Britta Fuglevand, MSHA Britta.Fuglevand@rmhp.org 970-712-7233 Section - Title