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
% FPL
Family of 4: $34,638

8. Apple Health clients by county

9. Flat trend for numbers of children living in poverty

10. Children living in poverty 2009-2013
<100%FPL

11. 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

12. Low birth rate <2500g by race 2016

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

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

17. 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):

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
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

21. State activities to transform the delivery system

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

23. Value-based purchasing

24. State’s VBP standard

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

27. Provide actionable data: Healthier Washington dashboard

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