Medical Professional Publications

Study Shows Successful Cost-Savings and Quality Outcomes of Pediatric ACO

(From the March 2015 Issue of PediatricsOnline)

A new study published in Pediatrics demonstrates the cost-saving and health care quality outcomes of the pediatric Accountable Care Organization (ACO) Partners for Kids. Results of this study indicate that Partners for Kids successfully improved the value of pediatric healthcare over time through cost containment, while maintaining quality of care.

Partners for Kids (PFK) is a pediatric ACO serving approximately 300,000 Medicaid-eligible children in Ohio, designed to address rising costs and concerns about the quality of care delivered to low-income patients. In 1994, Nationwide Children’s Hospital partnered with community pediatricians to create PFK, a physician-hospital organization with governance shared equally between Nationwide Children’s and physician primary and specialty practice groups. ACOs are responsible for healthcare costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality and outcomes of care.

“We believe this study is the first evaluation of a pediatric ACO. Our data demonstrate the potential for an ACO to minimize the growth in cost of care for a pediatric population, all while maintaining or improving quality of care,” says lead author Kelly Kelleher, MD, MPH, vice president of Community Health Services at Nationwide Children’s and a member of the faculty at The Ohio State University College of Medicine.

The study assessed the value of care provided by PFK from January 2008 through December 2013. Costs of care were compared to overall reported costs of Medicaid within Ohio. Quality measures were derived from the Agency for Healthcare Research and Quality (AHRQ) Pediatric Quality Indicators, which focus on potentially preventable complications and hospitalizations and provide targets for interventions at both the provider and patient level. Four additional measures targeted specifically by PFK included neonatal intensive care days; emergency department visits due to asthma; diabetes care management; and 3- to 6-year-old well-child checks.

Results of cost comparisons indicated that PFK had lower cost growth than Medicaid fee-for-service programs and Medicaid managed care plans. From 2008 to 2013, costs per member per month for PFK grew at a rate of $2.40 per year. Managed care plans grew at a rate of $6.47 per year and Medicaid fee-for-service costs grew at a rate of $16.15 per year.

Quality metrics based on AHRQ indicators stayed consistent on most other measures, showed improvement for three measures (including two measures of overall quality of care), and declined on two measures. PFK-specific quality measures showed improvements including fewer NICU days, fewer visits to the ED for asthma and a significant increase in the number of well-child visits. A slight deterioration was seen in diabetes care management.

Overall, the results indicate the PFK model substantially reduced growth in the cost of care compared to other Ohio Medicaid plans. In addition, quality-of-care measures held steady, with some small changes in both directions.

“PFK delivered on the promise of the ACO to reduce the rate of health care cost growth while maintaining or improving the quality of care,” Dr. Kelleher states.

Pediatric ACOs may prove to be efficient models of reforming healthcare, Dr. Kelleher says. The National Committee on Quality Assurance, a non-profit organization dedicated to improving health care quality, is developing an accreditation and measurement proposal for ACOs. PFK will participate in its analysis.

“While an additional 30 million Americans will have access to health coverage under the Patient Protection and Affordable Care Act, the difficult work of creating a system of better care, better health and lower cost will occur gradually, through pilot projects designed to encourage innovation, improve effectiveness and reduce costs,” explains study co-author Richard Brilli, MD, chief medical officer at Nationwide Children’s and a member of the faculty at The Ohio State University College of Medicine. “One of the primary vehicles through which the new law encourages such innovation is through provisions that establish Accountable Care Organizations in Medicare and for pediatrics, in Medicaid or CHIP.”

About Partners for Kids
Partners for Kids is a physician hospital organization (PHO) currently composed of over 900 physicians caring for children and adolescents, including primary care physicians, pediatricians, specialty care providers and our sponsoring hospital, Nationwide Children’s Hospital.

Since 1994, our network has offered a comprehensive range of health care services to health plans under our managed care agreements. Our primary goal is to improve quality and access for the patients who we jointly serve throughout the Central and Southeastern Ohio regions.

About Nationwide Children’s Hospital
Ranked 7th of only 10 children's hospitals on U.S. News & World Report’s 2014-15 “America’s Best Children’s Hospitals Honor Roll,” Nationwide Children’s Hospital is one of the nation’s largest not-for-profit freestanding pediatric healthcare networks providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children and adolescents, as well as adult patients with congenital disease. Nationwide Children’s, also ranked among the Top 10 on Parents magazine’s 2013 “Best Children’s Hospitals” list, has a medical staff of 1,100 and nearly 10,000 employees providing state-of-the-art pediatric care for one million patient visits annually. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s physicians train the next generation of pediatricians and pediatric specialists. The Research Institute at Nationwide Children’s Hospital is one of the top ten National Institutes of Health-funded freestanding pediatric research facilities. Nationwide Children’s remains true to the original mission since its founding in 1892 of providing care regardless of a family’s ability to pay. More information is available at NationwideChildrens.org.

Citation:

Kelleher K, Cooper J,  Deans K, Carr P, Brilli RJ, Allen S, Gardner W. Cost Saving and Quality of Care in a Pediatric Accountable Care Organization. Pediatrics. Feb 9, 2015 [epub ahead of print]

This study was supported in part by Funding Opportunity Number CMS-1c1-12-0001 from the Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation.

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