ACOs support programs that increase value in pediatrics

Accountable care organizations (ACOs) improve quality and value in treating the 3 million children with medical complexity in the U.S., according to a study published in the January 2017 issue of Pediatrics.

Children with medical complexity comprise about 6% of children on Medicaid, yet consume 40% of Medicaid dollars spent on children, according to study author Garey Noritz, MD, Nationwide Children’s Hospital, Columbus, Ohio.

Noritz and colleagues found that a concerted institutional initiative, in the context of an ACO, can be part of the solution for improving outcomes and healthcare value for children with medical complexity, according to the authors.

They designed a multifaceted initiative to improve the care of children with medical complexity-specifically, children with neurologic impairment and a feeding tube. Experts in relevant fields came together to plan interventions; these included neurodevelopmental pediatricians, gastroenterologists, surgeons, nurses, dieticians, parents, and hospital administrators.

This population-based initiative showed promising results in improving health through nutrition to achieve a healthy weight and a reduction in charges by implementing a care coordination program.“Our interventions included improved family education, standardized management of the feeding tube, and institution of a robust, proactive, care coordination system,” Noritz says. “Buy-in was broadly sought. Data analysts were involved from the conception of the study. We believe the care coordination piece was key and is a worthy investment for healthcare systems. The savings realized compared to the investment in this program was 680%.”

Noritz

Over the three-year study (January 2011 and December 2014) period, the authors observed:

• 18.0% decrease in admissions

• 31.9% decrease in the average length of stay (in the hospital) for children in the cohort.

• Total inpatient charges reduced by $11,764,856.

• 8.2% increase in the percentage of children with healthy weights.

“Managed care executives should know that the organizational structure of an ACO supports programs that increase healthcare value,” Noritz says. “In addition, provider incentives are aligned with increasing healthcare value, rather than increasing billing, as in the fee-for-service model.”

Programs at the population level-rather than the level of doctors and clinics-are needed to improve the care of populations, according to Noritz. “Our care coordination program helped patients broadly, including interfacing with the medical system, school system, insurance, and social service systems,” he says.

“We have always believed that proactive care coordination and family engagement are key to improving outcomes for children with special needs,” Noritz adds. “The ability for the ACO to efficiently organize care and incentivize high-value care is a fundamental change in the health care system which can improve care while lowering costs. Investment in care coordination is a worthy expense compared to the savings that can be realized through better patient engagement and organization of the healthcare system. A comprehensive approach achieved Triple Aim success with this high-need population. An important marker of overall health [weight status] improved, while care was more efficiently organized and proactive care coordination was provided to families.”

Noritz believes that it is premature to speculate the future of ACOs under a new administration, “but our findings suggest that the ACO structure is a viable option for improving health while decreasing costs,” he says. “Hopefully, these findings and others will resonate with the new administration.”