Health Care Innovation
At Children’s, we understand that the health care landscape is rapidly changing, and that the way we do business is going to change. Children’s is undertaking a number of initiatives to make our hospital system a model for pediatric care in the country.
Accountable Care Organizations
As an example, Children’s is one of the phase one projects in the Minnesota Department of Health’s (MDH) Healthcare Delivery System demonstration project. One of these is the Health Care Demonstration.
In 2011, the state of Minnesota undertook a nation-leading effort to streamline care for its 600,000+ Minnesota Health Care Programs (MHCP) patients. Children’s was one of 9 providers statewide chosen to participate in the new HCDS demonstration project.
The HCDS project is Minnesota’s first attempt at an Accountable Care Organization-type fee arrangement. Under the HCDS, Children’s will contract with the Minnesota Department of Human Services (DHS) to care for MHCP patients in both fee-for-service and managed care under a payment model that holds Children’s accountable for the total cost of care and quality of services provided. Children’s will be gauged on performance against a risk-adjusted total cost of care target for all qualifying MHCP participants. The amount of shared gain/loss will be negotiated with DHS.
Children’s is excited to partner with DHS, and looks forward to providing coordinated, streamlined care to Minnesota’s children.
Children’s campus-based primary care clinics are currently a state-certified Health Care Home (“HCH”), caring for more than 1,000 children with medically complex needs. Children’s was a pioneer in establishing this coordinated model, operating one of the first pilots projects which helped shape the model the state uses today.
The HCH model includes coordinators who work with families to provide more personalized and efficient services in concert with the physician's care. Regularly scheduled clinic visits allow for additional time to evaluate and coordinate care, including access to ancillary services such as dietary services and social work, as well as assistance with scheduling specialty appointments. Over the course of our HCH’s existence, the model has demonstrated significant savings. In its first full year of operation, Children’s HCH saved the health care system more than $2.5 million in fewer clinic visits and hospitalizations. Because of the success of the HCH, Children’s intends to extend the applicable parts of its HCH care coordination model to additional primary care patients.
Children’s HCH program initiated an innovative pilot project to evaluate the effectiveness of medication therapy management (“MTM”) in a pediatric medical home setting. The program utilizes an on-site pharmacist in the clinic setting. The pharmacist is responsible for meeting with patients and families, reviewing the patient’s medication, looking for medication therapy problems, and finding ways to improve the medication regimens. In the first iteration of the pilot, 37 patients were seen and 93 drug therapy problems were identified and addressed. A majority of these patients, 29 of 37, were enrolled in Minnesota public health care programs. The MTM model provides an excellent opportunity to identify medication therapy problems and reduce unnecessary medication use and cost.