MM Curator summary
A children’s hospital is starting a Medicaid ACO for children.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
Akron Children’s Hospital is creating a new subsidiary to help coordinate and improve overall care of 100,000 Medicaid patients in a 13-county region.
The new company called the Akron Children’s Health Collaborative will be what’s called an accountable care organization or ACO.
An ACO is a “partnership between doctors, hospital and other health care providers that work together to offer high quality care at a lower cost and directly with insurers,” said Kris Grayem, Akron Children’s vice president of population health.
The first contract for the new company is with CareSource, the largest insurer of Medicaid-covered children in the state. The collaboration will begin Oct. 1.
Akron Children’s is in negotiations with the other Medicaid managed-care insurers for children in its 35-county coverage area to create similar collaborations, hopefully within the next six months to a year, said Shawn Lyden, Akron Children’s chief strategy officer.
This will be Children’s first foray into an ACO.
Instead of getting paid every time a child covered by CareSource is seen at the hospital or at Children’s physician offices, Children’s will receive a set amount of money per CareSource enrollee per month, according to Grace Wakulchik, Children’s Hospital president and CEO.
With those funds, the company is “entrusted to use to care for these group of Medicaid children,” Wakulchik said. “The thought being with our excellent clinical coordination systems, we can coordinate that care better so that those kids get better front-end care. So we manage their health better so there aren’t those adverse expensive hospitalizations.
“We want to intervene early. We want to coordinate your care. We want to have the best possible outcome and so that’s the risk we are taking by accepting this per member per month amount that we will be able to manage that care better for those families,” she said.
Akron Children’s officials declined to share financial details of the contract.
How does the Akron Children’s Health Collaborative work?
Currently, the hospital loses money on each Medicaid patient, Wakulchik said.
“We’re hoping by managing kids getting preventive care, dental care and other care, we’ll be able to manage their care when it costs less not only to us but to keep the kids healthier,” she said. “In the long run, I don’t know this will be as profitable per se, but hopefully we won’t lose as much money.”
About 42% of the 100,000 children who will be part of this new care model are currently Akron Children’s patients and already get some of the holistic care through the hospital’s population health efforts, which started in 2017, Lyden said.
For instance, Children’s already has been helping with other social barriers to health care —such as transportation needs, food insecurity and housing needs — for its existing Medicaid patients, said Grayem.
But 58% of children covered in the new collaborative have primary care physicians who are independent practitioners or aren’t affiliated with Children’s. The monthly money Children’s collaborative will get can be used for some of those same social barriers for all covered children in the plan, according to Lyden and Wakulchik.
Part of the model will be partnering with those providers to engage them in the proactive care of the children. Those independent practitioners still have their contract with CareSource and also will receive an incentive from Children’s ACO company to work together.
An example, Wakulchik said, is “say we have a pathway that helps asthmatics stay out of the hospital. We’re not just going to use that for patients we serve in Akron Children’s. We want to work with our community partners and they will use them in their practice to help keep them healthier.”
Medicaid is Akron Children’s single largest payor, accounting for 53% of total charge, Lyden said.
“This is a ripe area for us to get involved in this accountable care population health,” he said.
Akron Children’s has been working with a network of independent physicians and federally qualified health centers to set up the collaborative and also will have five members on the collaborative board, Wakulchik said.
In a statement, CareSource Ohio Market President Steve Ringel said “CareSource’s history is built on breaking down the barriers of health care to increase access to seamless high-quality cost-effective care.
“Our partnership with Akron Children’s Hospital will continue to support our youngest members and their families in northeast Ohio.”
13 counties covered
The collaborative’s CareSource contract will cover 13 counties: Summit, Stark, Portage, Wayne, Medina, Ashland, Carroll, Holmes, Tuscarawas, Trumbull, Mahoning, Columbiana and Huron.
There are still another 120,000 Medicaid-covered children in the 13 counties with other insurers that are not yet covered under this new model, Lyden said.
Akron Children’s currently has a 35-county service area and will consider opportunities to expand the collaborative in future years, he aid.
The new model is not a “patient-steering mechanism” to try to get more patients to Akron Children’s facilities, Wakulchik said. While she would like it if working with more community partners would involve better access to Akron Children’s facilities, the collaborative would be responsible for children’s care in the program anywhere they go.
“They can go anywhere they want,” Lyden added. “They could go to Columbus and it’s still on our nickel. It still comes out on our fixed payment.”
Said Grayem: “The main thing is we want to improve the health of kids by focusing on quality and improving health equity for better outcomes.”
Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or email@example.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher