Partners For Kids: Pediatric Accountable Care

Partners For Kids is a crucial link between families, health care providers and Ohio’s Medicaid system, allowing children to get the high-quality care they need when they need it and where they need it.

As one of the largest nonprofit programs of its kind in the United States, Partners For Kids has the ability to improve children’s health and save money for the overall health care system.

  • Partners For Kids uses an accountable care organization model. It brings together a premier pediatric medical center – its home institution, Nationwide Children’s Hospital – and more than 2,100 individual providers.
  • Working in partnership, they can deliver coordinated services to more than 325,000 children per year in south central and southeastern Ohio, from primary care well checks to treatment for the most serious conditions.

Chart from PFK Progress ReportEarly, high-quality well care can help prevent later disease. Coordinated care of chronic and complex conditions can reduce the number of stressful, expensive hospital visits now and in the future. And because Partners For Kids has unique access to data for hundreds of thousands of children, it has the ability to conduct population-level research to drive better health.

Founded in 1994, Partners For Kids both helped define what a pediatric accountable care organization can be and continues to lead the way in value-based care.

Partners For Kids at a Glance

  • Responsible for approximately 325,000 unique children annually
  • 3,000 unique children enrolled in care navigation
  • 2,100+ providers in the Partners For Kids network, including 446 behavioral health providers
  • 33 practices participating in quality improvement programs
  • 147 staff members

The Impact

Reduction in Emergency Department Visits

Chart from PFK Progress Report

Patients at Partners For Kids-contracted primary care providers consistently have fewer visits to emergency departments (ED) than children in our region who see other providers.

Partners For Kids helps community providers reduce ED utilization by providing appropriate, high-quality preventative care and placing special emphasis on the ongoing care of chronic conditions that are common drivers of ED visits, such as asthma.

Reduction in Inpatient Days

Chart from PFK Progress Report

Children have significantly fewer hospital inpatient bed days after they are enrolled in Partners For Kids’ Care Navigation program.

A small percentage of patients covered by Partners For Kids have conditions that require more involved ongoing care: visits to multiple specialists, physical and occupational therapy, and complicated medication regimens. These children can be at higher risk for hospitalization.

Partners For Kids’ Care Navigation program focuses on these children and their families. By aiding them as they navigate regular, ongoing care and connecting them to important community resources, coordinators can help reduce their need for inpatient care.

Improvement in Prescribing Medications for ADHD

Chart from PFK Progress Report

Approximately 26,000 patients covered by Partners For Kids have been diagnosed with attention deficit hyperactivity disorder (ADHD), and approximately 20% of the total money spent on medications in the Partners For Kids system is spent on ADHD medications.

Dozens of similarly-acting medications can be prescribed for children with ADHD, and it can be difficult for providers to keep up with the differences among them. But it’s critical that each child receives the medication that is most likely to be of benefit.

Partners For Kids pharmacists have developed a number of tools to help providers make the most appropriate decisions. In addition, practices can participate in a quality improvement project focused on proper management of ADHD.

The improved ADHD prescribing from 2016 to 2019 was associated with a savings of more than $1 million.

Four-Year Trends: Results in Key Areas

Health care plans in Ohio and across the country rely on the Healthcare Effectiveness Data and Information Set (HEDIS) to measure dozens of performance indicators. Partners For Kids uses these HEDIS statistics from Ohio’s Medicaid managed care plans to track effectiveness in helping providers give children high-quality care.

As these HEDIS measures from 2015-2018 show, providers who are directly affiliated with Partners For Kids consistently improve in key high-quality care indicators and outperform other community providers in those same indicators.

Childhood Well-Child Visits

Chart from PFK Progress Report

Most families know to take children to the doctor when they are sick. It can be more difficult to have children come in for well-child visits. But those well-visits are crucial for keeping children healthy, for adhering to suggested immunization schedules or for ongoing management of chronic conditions.

Those visits ultimately help save families and the health care system time and money. The American Academy of Pediatrics and other professional medical organizations recommend a set schedule for those visits.

One HEDIS measure tracks well visits for children younger than 15 months; six or more well visits are considered optimal for that age group. Another measure tracks crucial well visits for children 3 to 6 years of age.

Partners For Kids provides staff members to affiliated providers to help track patients’ well visit schedules, to help make well-visit appointments for patients and to remind families when visits are due.

Adolescent Well-Child Visits and Immunizations

Chart from PFK Progress Report

Rates of annual well-child visits often decline as children grow into adolescence, even though adolescence is a crucial developmental period for future health. 

Primary care providers are important resources throughout puberty as they provide medical guidance about reproductive health and birth control. Decisions made during teenage years about diet, activity, drug and alcohol use and a host of other health-related issues have a lifelong impact.

One HEDIS measure tracks well visits for adolescents and young adults 12 to 21 years of age. Others track certain immunizations that adolescents have by age 13.

Partners For Kids, through a number of incentives and quality improvement projects, puts a special focus on adolescent health indicators.

Primary Care Access

Chart from PFK Progress Report

 A primary care provider’s ongoing relationship with individual patients and families allows for better insight into medical management. A regular visit, even for an illness, helps deepen and expand the relationship. Urgent, emergency and specialty care have important roles, but should be reserved for special circumstances.

This HEDIS measure is an indication of child and adolescent access to primary care. It uses age-based categories to determine the percentages of children and adolescents who have a primary care visit.

Partners For Kids-contracted providers have more regular visits than their non-contracted peers, a result of many Partners For Kids initiatives.

Appropriate Management of a Sore Throat

Chart from PFK Progress Report

Pharyngitis, or a sore throat from many possible causes, is one of the most common reasons for children to visit their primary care provider. It’s also a condition that can lead to the incorrect prescription of medications.

Antibiotics are effective if the cause of the pharyngitis is bacterial, as with strep throat (caused by A Streptococcus bacteria). Antibiotics prescribed for viral pharyngitis are not only ineffective, but they may contribute to the development of allergy or other adverse conditions for individual patients. These misprescribed antibiotics also contribute to population-level antibiotic resistance, a public health threat.

This measure tracks the appropriate diagnosis, testing and treatment of pharyngitis. A higher rate means that antibiotics are prescribed after a positive bacterial test. Partners For Kids works with providers to ensure that medications are prescribed only when they are most likely to benefit patients.