Funder: Robert Wood Johnson Foundation
Summary: Recent payment reform efforts have given rise to promising models for improving the value of health care. Yet little is known about which payment approaches can best address the unique challenges of caring for our most vulnerable populations. From 2012 through 2015, stakeholders in Allegheny County, Pennsylvania, developed a new pathway for Medicaid payment reform that improved the value of care for children with medically complex conditions.
The UPMC High Value Care for Kids model was facilitated within UPMC's integrated delivery and financing system with the leadership and resources of these partners:
This project comprised three components:
Within the UPMC for You pediatric member population, 10 percent of members who had consistently high costs were identified: about 1,300 children and adolescents with diverse medical conditions in Allegheny County. Of that population, a total of 263 children and youth who were patients at one of four UPMC pediatric practices (three CCP practices and GAP) were identified as the target. It was recognized that this group would present the greatest potential to impact families on a personal level, while also achieving cost savings.
Practice-based care coordination deepened the staff's understanding of the unique needs and challenges these families face, such as financial barriers and special accommodations for their child. This understanding, in turn, improved the level of assistance and care given to the child. Families reported that they felt supported by the project. They appreciated the availability of consumer-directed funds for products and services to improve the health and quality of life of their child. Many of these factors helped to reduce parental stress in caring for their child and contributed to an overall better quality of life for the family unit.
The financial impact of UPMC High Value Care for Kids was significant: in-patient medical care, emergency department visits, home care, and specialist services saw the greatest reductions in cost. There was an annual reduction of 9.1 percent in overall expenditures. Click here to download the final data on cost reduction for the entire project of UPMC High Value Care for Kids.
This project was successful in demonstrating and documenting a set of replicable methods and strategies to be used by other stakeholders as a roadmap for designing, implementing, and evaluating similar value based payment models. Learn more about these strategies and methods below.
This manual serves as a roadmap for organizations looking for replicable strategies, methods, and tools to guide similar and/or related value-based payment models. It is divided into six sections that describe the steps that were taken over the course of the project:
Download the full manual here.
This is a supplement to the "How-To" Manual. Each of the resources below is linked to a downloadable document for viewing, and in some cases, editing. (Some files are large; please be patient while loading.)
UPMC is a global health enterprise and one of the nation's largest integrated health care delivery and financing systems. The UPMC Center for High-Value Health Care translates the work of this unique payer-provider laboratory into evidence-based practice and policy change for improving health care quality and efficiency. Many Center activities are supported through grants and contracts and conducted in partnership with community organizations and government agencies.
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UPMC and its Insurance Services Division recognize the value of collaboration in achieving an equitable, high-quality, and efficient health care system that meets the needs of diverse populations. We invite all interested stakeholders to join in this effort.
UPMC Center for High-Value Health Care is proud to be a member of the Accountable Care Organization Learning Network, a group that helps organizations successfully implement accountable care.