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

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

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

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

Apple Health clients by age

Apple Health clients by race/ethnicity

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

Apple Health clients by county

Flat trend for numbers of children living in poverty

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

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

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

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.

Social determinants of health

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Team-based care: evidence suggests outcomes are improved

Team-based care Intermountain health care 51K patients over 4 years 51000 patients followed for 4 years. Team based care vs. usual practice. Boxes areas show significant changes in outcomes. Reiss-Brennan, B. et.al. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA 2016;316(8):826-834

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

The basic science of pediatrics The basic science of pediatrics. An emerging, multidisciplinary science of development supports an EBD framework for understanding the evolution of human health and disease across the life span. In recent decades, epidemiology, developmental psychology, and longitudinal studies of early childhood interventions have demonstrated significant associations (hashed red arrow) between the ecology of childhood and a wide range of developmental outcomes and life course trajectories. Concurrently, advances in the biological sciences, particularly in developmental neuroscience and epigenetics, have made parallel progress in beginning to elucidate the biological mechanisms (solid arrows) underlying these important associations. The convergence of these diverse disciplines defines a promising new basic science of pediatrics. Jack P. Shonkoff et al. Pediatrics 2012;129:e232-e246

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State activities to transform the delivery system

Payment re-design and value-based purchasing strategies

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

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

2017 measures with 0.75% withhold for managed care plan performance

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

Focusing interventions at a regional level

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

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

Discussion

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