System-Level Approaches to Identify Children with Health Complexity and Develop Models for Complex Care Management
OPIP is leading efforts to support health systems to develop and implement standardized methods to identify children with health complexity and to then use this information to engage communities and consider best match care coordination strategies. The unique population of CYSHCN for this project are children with Health Complexity that could be impacted by a complex care management program meant to improve health outcomes and address health care costs. Children with health complexity will be defined as those who:
- Are Medically Complex as defined by the Pediatric Medical Complexity Algorithm (PMCA), with a priority focus on children identified with “complex chronic disease” OR children with “non-complex chronic disease”, AND
- Are Socially Complex as defined by The Center of Excellence on Quality of Care Measures for Children with Complex Needs (COE4CCN) as “A set of co-occurring individual, family or community characteristics that can have a direct impact on health outcomes or an indirect impact by affecting a child’s access to care and/or a family’s ability to engage in recommended medical and mental health treatments”. Specifically, KPNW will be defining children as socially complex if the system-level data they have indicates the presence of one or more of the 14 factors identified by COE4CCN as predictive of a high cost health care event (e.g. emergency room use).
These efforts are supported through grants from the Lucile Packard Foundation for Children’s Health (LPFCH) and contract from the Oregon Health Authority to provide technical assistance to Coordinated Care Organizations, networks of all types of health care providers (physical health care, addictions and mental health care and dental care providers) who work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid).
LPFCH Grant #1:
The first grant, conducted August 2017 – March 2019, aimed to inform Health Systems on novel and generalizable approaches to identify and design Complex Care Management programs for children with Health Complexity. This effort engaged 1) Kaiser Permanente Northwest (KPNW), 2) Oregon Health Authority (OHA), and 3) Coordinated Care Organizations (CCOs).
Kaiser Permanente Northwest: OPIP facilitated KPNW on the development of a pediatric team-based care (TBC) program in order to summarize learnings related to: 1) use of KPNW-level medical and social complexity data to identify children with health complexity for TBC; and 2) tools for administering a pediatric TBC program. Click here for more information.
Oregon Health Authority: OPIP facilitated OHA on novel methods for using state-level medical and social complexity data for identifying children with health complexity. Additionally, OPIP will facilitate OHA on using this population-level information to inform state-level policies and contracting. OPIP will then facilitate OHA on how to share child-level data about health complexity with the CCOs it contracts with for publicly insured children, in order to inform their pediatric complex care management programs. Click here for more information.
Coordinated Care Organizations: OPIP facilitated conversations with CCOs around how to use the OHA data for identifying children with health complexity, and around care management methods, tools, and strategies from KP that can be applied. Regional variations used by CCOs given differing internal resources, community resources, and patient demographics, will be examined. Click here for more information.
A specific effort has been made to engage stakeholders from across the state in order to provide guidance and input on methods and processes for this work. Below you will find links to slides and webinar recordings of stakeholder meetings held to date.
- Click here for meeting agenda
- Click here for an ebook of supplemental meeting materials
- Click here for Complex Care Management Resources
LPFCH Grant #2:
The second grant, which runs May 2019-April 2021, is meant to support the meaningful use of population-level health complexity data to drive improved policies and investments in care and health management supports for children with health complexity.
The project supports OPIP to provide targeted technical assistance to the Oregon Health Authority to identify specific policies, investments, and contracting requirements that can impact children with medical complexity. OPIP will provide technical assistance to OHA to focus on how the CCO 2.0 policies related to spending on social determinants of health, health equity, and health disparities; value-based payments focused on children, behavioral health services for parents and young children; fully implemented Systems of Care and wrap around services can be leveraged to focus on children with medical complexity.
The project will also support OPIP and OHA to share nationally the data analytic model for children’s health complexity, the compelling findings that demonstrate the magnitude and number of children with health complexity, and how the data model can be adopted by other State Medicaid agencies, given we know that what is measured is what is focused on.
At the end of the project, OPIP and OHA will develop a summary brief of the specific policies, investments, and contracting requirements that were implemented over the course of the project so that other State Medicaid agencies can learn about potential levers they can implement in their own states.
Secondly, the funding from this project will be used to complement the funding OPIP has received from OHA to provide deeper and more robust technical assistance to a limited number of CCOs or health care providers identified by CCOs within their region. CCOs that identify a specific focus on children with medical complexity and interest in developing models of complex health and care management for these children will be supported.
OPIP will provide nuanced and tailored technical assistance for the selected regional CCOs to apply and operationalize models of complex health management that fit their population, their contracting structures and health care partners. OPIP will share the learnings from the KPNW PCT model that apply to CCOs, as well as other methods identified through the development work with KPNW that were not implemented due to lack of fit within that setting but that may apply in the CCO or with a specific health care provider. A key component of this technical assistance will be working with these partners to ensure that the patient voice and patient input is obtained.
OPIP will share methods on how patients can be engaged, connect CCOs to state-level patient advocacy groups, and will provide facilitation supports for meetings with patients held about the improvement change concepts and models identified. A summary brief will then be created based on the learnings from these efforts that will be shared with other health care systems, including other CCOs in the state.