Comprehensive Care Coordination for Pediatric Populations with Disabilities

1. Comprehensive Care Coordination for Pediatric Populations with Disabilities Medicaid and CHIP Payment and Access Commission Presentation November 2012

3. The HSC Health Care System • Integrated pediatric and young adult special needs health care system • Non-profit; 130 years old, 6,000+ served in direct services; national reach broader • HSCSN-DC only (and out-of-state placements) • HSC Pediatric Center- DC, MD, VA • HSC Home Care-DC, MD • Special Needs Consulting Services- national • National Youth Transitions Center* age 14-26

4. Health Services for Children With Special Needs (HSCSN) • Care coordination plan for individuals up to age 26 in SSI and related categories via Medicaid CASSIP • A 20 year old program with longitudinal data • Now 5,400+ members/ 60%+ of eligible • Comprehensive coverage with no carve-outs • At risk contract with risk share • District has 14.7% with special needs vs. national average of 13.5%

5. Organization Approach • Integrated care management incorporating social care management to help families dealing with disabilities achieve their highest level of independence • Model includes behavioral, long term care and recovery model interventions • Network more community and social focused than a typical MCO • All members receive care management and outreach • Linked to a special needs focused delivery system

6. HSCSN Value Equation Approach care delivery with granularity; initial home and family assessment—across continuum Aggressive family support addressing social determinants; support groups include Male Caregivers and others 67% of plan employees have direct engagement roles with members Active peer to peer support, engagement with schools, governmental agencies and NGO’s 6

7. Enrollment By Diagnosis

8. Caregivers • A vital factor for children • Affected by social determinants • 79% are biological mothers • 10% are grandmothers • 1/5 < 30 years of age • Housing is a major barrier • Foster care system is major decision maker for 2% of members

9. Major Outcomes • Better access to Primary and Specialty Care than FFS • 47% increase in access to dental services • Cumulative rate increases 55% below commercial insurance PMPM cost norms from 1996-2009. • From 2003-2008 costs increases were 17% for HSCSN population compared to 23% in the District and 21% nationally for all Medicaid SSI. • 55% decrease in ICFMR and LTC residential use • 50% decrease in use of out-of-state facilities

10. Additional Analytic Findings • 2,602 members continuously enrolled during 2008-2010. Group was 68% of all members and 58% of incurred medical costs during timeframe. • PMPM for this group increased only 2.5% annually during 2008-2010 • Providers with 35 - 50 patients have highest EPSDT rates (92% compliance) • Providers with 150 -250 patients have lowest EPSDT rates (77% to 64%). Equal to very small panels e.g. 1

11. Residential Treatment Utilization

12. 2010 NCQA Quality Compass Results • National Comparison: • 46 out of 90 reported measures • SN exceeded the both the national Medicaid average and ACAP plan average in 36 measures or just under 80% of HSCSN’s reported measures

13. Lessons/Recommendations • Cover social determinant interventions outside of the pure clinically based realm • Support capacity building to support NGOs in affecting above re: data, reporting and outcomes focus [e.g. managed care rigor] • Stimulate development of a “real provider systems of care” rather than just an “insurance” approach • Use ASO arrangements whenever possible

14. Lessons/Recommendations • Remove risk requirements beyond plan control • Build granular best practices, e.g. • Hand-offs between medical to behavioral care • Use defined structures to engage family, providers, schools, NGOs, and government • Define “care coordination” for all stakeholders • Cover entire family and not just the member • Engage individuals with disabilities in solutions

15. Contact Information John Mathewson Executive Vice President HSC Foundation 202-454-1236 jmathewson@cscn.org