Making Health Care Accountable

“Early adopting” Rainbow Care Connection ACO leads the way

Innovations in Pediatrics - Spring 2017

 Andrew Hertz, MD

Is it possible to improve healthcare quality while lowering costs? Accountable care organizations (ACOs), established after the passage of the Affordable Care Act, are showing that the answer is ‘yes.’

At University Hospitals Rainbow Babies & Children’s Hospital, a pediatric ACO dubbed Rainbow Care Connection is exhibit A. Established with a $12.7 million grant from the Center for Medicare and Medicaid Innovation as one of the first pediatric ACOs in the country, its approach has yielded compelling results. Since the Rainbow Care Connection’s inception in 2012, preliminary data shows that:

• Hospitalizations for children with behavioral health conditions have fallen by 57 percent. 
• Hospitalizations for children with medically complex conditions have fallen by 25 percent.
• Avoidable emergency department visits have fallen by 22 percent.
• Hospital readmissions have fallen by 17 percent.

These results were achieved while creating a two-year total cost of care savings to Medicaid managed care plans of 5.6 percent (as determined by an independent claims-based analysis by Mercer).

“We set specific goals when we launched Rainbow Care Connection to improve care for all children and lower the cost of care at the same time,” says Andrew Hertz, MD, Vice President of the UH Rainbow Primary Care Institute and Medical Director of Rainbow Care Connection and Assistant Clinical Professor of Pediatrics, Case Western Reserve University School of Medicine. “We were far more successful than anticipated. We plan to assist others across the country in implementing a similar care model in their organizations.”

Rainbow Care Connection, recently featured in the journal Pediatrics as an “early adopter” ACO, impacts 225,000 children in Northeast Ohio, one-third of whom are Medicaid recipients. It relies on a broad and diverse physician network, 60 percent of whom are employed by the hospital system and 40 percent of whom are independent providers. Payment reform for Rainbow Care Connection is based on shared-savings agreements with Ohio’s Medicaid managed care plans. To manage its population health initiatives, Rainbow Care Connection uses robust medical claims analytics to identify high and low care utilizers for targeted education and outreach. Specific targets are patients who frequent the emergency department, are overdue for a well visit, or have incomplete vaccinations.

“We’ve taught practices to start thinking not just about the patient that’s there, but also the patient that’s not there,” says Dr. Hertz.

In addition to patient outreach, Rainbow Care Connection involves significant outreach to its own providers.

“The cornerstone of our program is the user of practice facilitators who act as ‘practice coaches,’” Dr. Hertz says. “A lot of ACOs might address gaps in care – getting patients in for overdue visits – but we have supported change both for patients and for physicians.”

Coaches visit individual pediatric practices for quality assessment and tailor their recommendations to each practice’s needs – a process dubbed “practice-tailored facilitation.”

“We’ll do a baseline assessment on 15 quality metrics and help practices figure out what they want to change in their practice to meet program goals,” Dr. Hertz says. “We give them scorecards every month in a transparent fashion so they can see how all the groups in the network are performing. It’s a large learning network where they learn best processes from each other and apply them in their own practices.”

Other innovations within Rainbow Care Connection include managing medically complex patients with a multidisciplinary team that includes physicians, nurse practitioners, nurse case managers, dietitians and social workers. For children and teens with behavioral health issues, Rainbow Care Connection pairs the primary care provider with a pediatric psychiatric social worker who provides evaluation right in the office. When acute issues arise, the primary care provider accesses a consultation line with mental health experts and a resource and referral program to link the patient with a community behavioral health agency.

Going forward, Dr. Hertz says the team has begun to bring this same approach to addressing social determinants of health, such as access to nutritious food and other family social support needs.

”We’ve started asking questions about patients’ social needs and trying to link them up with community services,” he says. “We hope to soon have the ability to connect patients with nutrition services in their providers’ offices, too. We’ve done behavioral health services and navigation. Nutrition is the next step.”

For more information on Rainbow Care Connection, email Peds.Innovations@UHhospitals.org.