As the U.S. continues to move into the “new” healthcare—one that puts an onus on cost effective value-based care—the question is not whether healthcare organizations should respond to the current population health management (PHM) trend, but instead how they are going to innovatively do so.
To date, population heath strategies have been mostly focused on adults, which on the surface makes sense, considering that the highest-cost and highest-utilization population is in the adult world. Certainly, population health in a pediatric environment is a new frontier in population health management that few organizations have tried to tackle, because of the enormous amount of effort it takes to customize the analytics technology and clinical protocols to address the unique needs of children, says Julie Harris, director of quality programs at the Portland, Ore.-based Children’s Health Alliance (CHA). CHA is a not-for-profit association of 100-plus independent primary care pediatricians in Oregon and southwest Washington who work together on improving quality in pediatric care through the Children’s Health Foundation, formed in 2007.
Indeed, robust systems and models for pediatric population health management have simply not been standardized, says Harris, who is also director of quality programs at the Foundation. Many health systems treat children as though they are small adults, but their needs are very different. Managing conditions such as attention deficit hyperactivity disorder, autism or multiple behavioral issues, requires different care approaches that adapt to the many developmental stages in a child’s life, she says. “Everyone recognizes that improving the health of children improves the health of adults down the road. But that’s not where volume and cost is,” Harris acknowledges. “Also, managing the most complex adult issues focuses on maybe three or four medical conditions, whereas addressing the most complex issues of children spans 10 or 15 issues,” she adds. “So the complexities are significantly higher in pediatrics, and that might also be why health IT’s population health efforts haven’t focused on this group.”
Since 2009, the Foundation’s goal has been to achieve better health outcomes by improving the understanding of child/family support needs and targeting proactive care management and coordination of medical, physical and behavioral health services for children, adolescents and their families, says Harris. “We wanted to look beyond the medical conditions of children, such as if a child was in a wheelchair or needed feeding assistance. Those are things that wouldn’t show up in clinical diagnosis code, but affects the level of support and care coordination needed for that child and his or her health,” Harris says. “We also included family factors, as children are dependent on their caregivers and parents. These are necessary for proper care coordination,” she says. Looking at all of those factors allowed pediatricians to focus on different set of criteria for assessing the needs of the families and patients, as well as what it would take to carry out care management, says Harris.
From L to R: Julie Harris, Albert Chaffin, M.D., Deborah Rumsey
Three Phases of Pediatric Care Management
Developing a pediatric-focused population health management framework is no small task, but it has become a pioneering achievement for the Children’s Health Alliance. Despite the challenges involved, the Foundation was determined to create its own model for pediatric population health management and implement it through educational efforts and the use of PHM technologies. In 2009, the Foundation began a quality improvement program for asthma care management improvement, including the development of a pediatric asthma registry. The group has, to date, achieved 80-800 percent increases in the number of patients receiving evidence-based clinical protocols in pediatric asthma care, Harris notes.
In 2012, the Foundation began hosting monthly pediatric care management improvement collaborative sessions in the community. The goal was to develop office-based care management competencies in pediatric practices through facilitated sharing amongst independent practices, targeted education and community engagement forums. The result of this effort was the development of a methodology to risk-stratify children with chronic health conditions, informed by an assessment of medical complexity, patient functioning, and family factors, Harris says. “The assessment tool enables pediatricians to identify the level of support the child/family needs in order to optimally manage his or her overall health. Within the first 20 months of this quality improvement effort, over 80,000 patients have been assessed and stratified to guide appropriate care management support and services,” Harris says.
Then, in 2014, the Foundation began implementing the successful child/family-focused pediatric care management approaches and quality measures it had developed into proactive care actions and alerts that could be supported by a population health management analytics solution. They chose a solution by the Alpharetta, Ga.-based Wellcentive, with the data aggregation, care management and analytics capabilities to successfully support pediatric PHM by translating evidence-based pediatric protocols into actionable care alerts and measures that are meaningful in promoting high quality primary pediatric care –such as developmental screenings, immunizations, chronic condition management and preventive care, says Harris.