Paying for Care Coordination

1
Paying for Care Coordination

• Deborah Allen, ScD
• Boston University School of Public Health
• Josie Thomas
• Parents Place of Maryland

2
(No Transcript)
3
State-at-a-Glance Chartbook The Catalyst Center

• Educational and inspirational tool for state
  policymakers and other stakeholders
• Key indicators of health care coverage for
  children and youth with special health care needs
  by state
• Descriptions of promising practices in improving
  coverage and financing

4
(No Transcript)
5
For more information, contact

• Meg Comeau, MHA
• Director
• The Catalyst Center
• Health and Disability Working Group
• Boston University School of Public Health
• 617-426-4447, ext. 27
• mcomeau_at_bu.edu
• www.hdwg.org/catalyst

6
Paying for Care Coordination

• Why it matters
• Strategic approach

7
Why it matters

• To Families
• Consistent findings that families place a high
  priority on care coordination
• Consistent findings that there is unmet need in
  this area
• To State Title V Program Staff
• Reflects Title V expertise
• Reflects Title V philosophy/systems approach
• Links public health to direct care and families
• To Providers
• Central to medical home model
• Most expensive component of medical home and
  thus, hardest to assure
• In relation to national 2010/New Freedom agenda
• May be most direct, concrete manifestation of
  family-centered, comprehensive, coordinated care
• Key test of system success

8
Starting assumptions --before you get to what it
costs

• Children with special health care needs are those
  who have or are at increased risk for a chronic
  physical, developmental, behavioral, or emotional
  condition and who also require health and related
  services of a type or amount beyond that required
  by children generally
• Any child or youth with special health care needs
  may need access to care coordination at some time
• An organized, statewide system of care
  coordination is the only way to assure universal
  access
• The medical home is the best option for a
  statewide system of care coordination
• Care coordinators in the medical home
• Can serve children and adolescents with a range
  of disabilities or chronic conditions effectively
• Can serve children and adolescents with a range
  of disabilities or chronic conditions efficiently
• See Chapel Hill Pediatrics presentation at
  http//www.medicalhomeinfo.org/model/MHLC.html

9
What have we learned from states

• No state has achieved universal access to medical
  home care coordination yet
• There may not be a single, universal formula for
  success
• But there has been enough progress to offer
  lessons related to two strategic objectives
• Bring down the cost
• Get partners to share the cost

10
Estimating the cost of care coordination
11
Why conduct the exercise

• Highlights key components of a system
• Drives debate within the field about optimal
  approach to system
• Makes statewide implementation a real possibility
  for policy makers

12
Relevant variables

• The number of children with special health care
  needs in the state
• Depends on population and percent CSHCN
• The caseload per FTE medical home care
  coordinator per year
• Depends on model
• The salary per FTE care coordinator per year
• Depends on model and local labor market

13
Case example Washington

• 2000 Census 1,513,843 under age 18
• National CSHCN Survey 13.7 reported to have
  special health care needs
• That means 207,396 children with special health
  care needs
• For purposes of estimation 200,000 CSHCN

14
The caseload per FTE care coordinator

• Depends on model and case mix
• For purposes of estimation
• Washington has 500 pediatricians about 250
  family practitioners see children
• -gtAverage primary care caseload is
  1.5mil/7502,000
• If assume 1 FTE care coordinator serves typical
  panel of 2,000
• -gtEach care coordinator serves about 275 CSHCN
• -gtSystem requires 750 care coordinators
• If assume 1 FTE care coordinator can actually
  serve 600 children and that a care coordinator
  can work with more than one provider
• -gt System requires 375 care coordinators

15
So lets roughly estimate

• 375 FTE care coordinators
• Distributed among 750 FTE physicians
• Each caring for about 530 children
• To serve the states population of 200,000 CYSHCN

16
Washington labor market salaries

• For nurse manager 37.75
• For staff nurse 30.54
• For health educator 24.22
• For medical/public health social
• worker 23.45
• For child and family social worker 17.62
• For trained paraprofessional 14.67

17
Annual salary

• At hourly rate of 35 72,800
• At hourly rate of 25 52,000
• At hourly rate of 15 31,200

18
System costs for 375 care coordinators with
benefits _at_ .25

• Advanced practice RN 34,125,000
• Social worker 24,375,000
• Certified paraprofessional 14,625,000
• Plus Estimate 2,000,000 in system oversight
  cost\
• -gt Cost is between 16 and 36 million

19
How are costs spread across system

• Cost of care coordination for CYSHCN per CYSHCN
• Range is 80 to 180/year
• Cost of care coordination for CYSHCN per child
• Range is 11 to 24/year
• 24 of Washington CYSHCN are enrolled in Medicaid
• Assume FFP covers ½ of 24 of total cost
• State cost would be reduced by 2-4 million

20
Does care coordination produce savings?

• Compare costs of care coordination to family
  costs
• 12 of Washington families of CYSHCN exceed
  1,000/year out of pocket
• Assume each of those families spends exactly
  1,000/year
• Then those families ALONE spend 24 million/year
• Possible sources of savings due to care
  coordination
• Inpatient care
• Number of hospitalizations or LO
• Cost of hospitalization/CSHCN almost four times
  cost/child nationally
• Specialty visits
• Cost for physician services for CSHCN more than
  two times cost/child nationally

21
Sources for estimating cost of statewide care
coordination

• Census http//www.census.gov/prod/2006pubs/07stata
  b/pop.pdf
• Percent CSHCN http//cshcndata.org/Content/States.
  aspx
• Salary per care coordinator http//www.bls.gov/oes
  /current/oessrcst.htm

22
The Catalyst Center on Financing and Coverage for
CYSHCN

• Our priorities
• Medical debt among families of CYSHCN
• Cover more kids through Medicaid buy-in
• Reduce gaps through Catastrophic Relief
• Enhance quality through financing of care
  coordination
• Our team
• Carol Tobias, Susan Epstein, Sally Bachman, Meg
  Comeau, Deborah Allen
• Find us at http//www.bu.edu/hdwg/
• Contact me at dallen_at_bu.edu