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Transition for Youth from Pediatrics to Adult Systems of Care: What is Different in 2012?

Transition for Youth from Pediatrics to Adult Systems of Care: What is Different in 2012?. Transition to Adult Care Symposium Boston, MA April 27, 2012 Richard C. Antonelli, MD, MS Assistant Professor of Pediatrics Medical Director of Integrated Care. Speaking of Transition….

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Transition for Youth from Pediatrics to Adult Systems of Care: What is Different in 2012?

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  1. Transition for Youth from Pediatrics to Adult Systems of Care:What is Different in 2012? Transition to Adult Care Symposium Boston, MA April 27, 2012 Richard C. Antonelli, MD, MS Assistant Professor of Pediatrics Medical Director of Integrated Care

  2. Speaking of Transition…

  3. Transition 2005 • Transition • You mean from hospital to nursing home? • Consensus Statement (2002) • Find adult providers willing to care of these youth • Rotate • Buy them gifts

  4. Transition 2011 • New Consensus Statement with algorithm • Increasing collaborations between pediatric and adult provider organizations • Increasing interest from academia • Development and promulgation of tools

  5. Transition 2012 • ACA • Eligibility for insurance • Triple Aim • Value Optimization • Quality • Cost

  6. What Do We Currently Measure? For CYSHCN, age 12‐17 years only: • The youth’s doctor has discussed each of the following with him/her (or parent indicated that such discussions were not needed): - Transitioning to doctors who treat adults - Changing health needs as youth becomes an adult - How to maintain health insurance as an adult 2. Doctor usually or always encourages the youth to take age‐appropriate responsibility for managing his or her own health needs Measure endorsed by the National Quality Forum (NQF)

  7. How Much Progress Are We Making?Or, Why Aren’t We? www.childhealthdata.org

  8. Impact by Type of Special Needs

  9. Impact of Emotional, DB Issues

  10. Role of Medical Home

  11. Disparities

  12. Opportunities • Identify patients meeting criteria for care coordination • Medical Home Matters • PCP-based • Subspecialty-based • Collaborative Care Models • Care Coordination • Case management • Look for ways to reduce costs • Unplanned readmissions • ED utilization for ambulatory sensitive conditions • Population-based approach

  13. Relationships Youth, Family, “Circle of Support”

  14. Example • Population: Patients w/ sickle cell disease • Outcomes to drive value • QoL • Graduation rates • Employment status • Cost by sector • Activities which support Care Coordination (CCMT)

  15. Patient with Sickle Cell Disease in Transition • Define “Episode of Care” • Time-Related • Service provision from 18th to 19th birthday • Preventive services – care guidelines • Episodic services – evidence-based • Patient-focused education • Financing– bundled; pmpm; FFS; global • Care Coordination • Risk adjustment

  16. What Must We Do Right Now? • Focus on Optimizing Value • Identify and track clinical outcome measures • Condition-specific • Process and structure measures are NOT sufficient • Create innovative, sustainable models of collaborative care • Focus on co-management and TME • Short and longer term savings critical • ACO structure • Define the population • Attribution may be challenge– or opportunity

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