HealthVine Connects Kids to Care and Brighter Futures
Improving child health relies heavily on building strong relationships—with patients and families, with internal and external care providers and other community partners. That’s where HealthVine comes in. Their mission is to coordinate care and support services for families that enable children to thrive by living their healthiest lives. Since their opening on January 1, they’ve already made some impressive headway.
HealthVine is a network of pediatric care providers and organizations backed by Cincinnati Children’s. It provides care management, quality improvement and utilization management for roughly 130,000 children in the eight southwest counties of Ohio who are covered by CareSource, the largest Medicaid provider in the state. As such, it is a key part of our strategy to provide best-in-class personalized care, outcomes, experience and value, which is outlined under the Care pillar in Pursuing Our Potential Together. Says Kim Kaas, assistant vice president of operations, External Medical Affairs, “As a delegate of CareSource, we are fully financially responsible for the healthcare of these 130,000 children. CareSource pays us a fixed amount per member per month, whether a child is receiving care or not. It behooves us then to put support and resources like care management in place to keep these kids out of the hospital, to help them be healthier and get the best outcomes. By doing this, we can also lower the cost of care.” Cincinnati Children’s has operated in this arena before. In 2013, Health Network by Cincinnati Children’s (HNCC) launched as a learning laboratory to test and develop new value-based care and payment models. Although their work was nationally recognized by other hospital systems, it proved unsustainable due to low patient volume.
HealthVine has taken the lessons from that experience and applied them to their current strategy. Says Kaas, “HNCC was set up as its own entity, with care managers who reported strictly to them. With HealthVine, we implemented a structure where the care managers report to Patient Services, just like their counterparts within Cincinnati Children’s. Another difference is that we have been delegated utilization management, which started on June 1. It’s a brand-new function for us where we will provide prior authorizations for the HealthVine population.”
HealthVine also includes behavioral health in its care management model. “The population we serve has a lot of behavioral health needs,” says Kaas. “Our clinical director, Jessica McLure, and administrative director, Kate Junger, are busy working with behavioral health agencies and partners to weave in resources with the care management team.” In addition, HealthVine has built a quality improvement team that will oversee outcome-based improvement work in partnership with the 60 southwest Ohio practices where most members receive their care. The data, gleaned from the HealthVine dashboard and other sources, will show which patients are most at risk, as well as where the most money is being spent (e.g., behavioral health, asthma, ED utilization and diabetes).
HealthVine and Pursuing Our Potential Together
The HealthVine network is an important step in fulfilling the Care pillar of our Strategic Plan. By coordinating community resources on behalf of patients and families, we are re-imagining how we deliver high-quality care to more kids in our region so they can have the best outcomes, experience and value.
HealthVine is part of External Medical Affairs, under the direction of Jeff Anderson, MD, vice president.
“Our intention is to support these patients where they are, not to take them away from their medical home,” says Kaas. “Some practices may have a robust care management model already, but many of them don’t. That’s where we can help by sending our care managers in to assist both the patients and the practices.”
Future Expansion
As more families and practices engage with HealthVine, the network’s impact will grow. The goal is to add all the Ohio Medicaid payors, which would increase the number of enrolled patients to 190,000. Longer-term, there are plans to enlist commercial and self-insured payors. They also hope to expand into Kentucky and Indiana.
“Our goal over time is to have value-based contracts with as many payors as possible—Medicaid, commercial or private—and to cover as many lives as we can in all three states,” says Kaas. To increase the opportunity for improvement, HealthVine leaders will also be connecting with other pediatric care management networks across the country to share what they’ve learned and adopt best practices. “Regardless of what happens in pediatric healthcare, the idea of value-based contracts is not going to go away,” says Kaas. “The insurance companies have seen how it’s been implemented on the adult side for a long time, and they understand its worth. Through HealthVine, we have the chance to show them that we can do good work in this area because we have the pediatric expertise to be successful.”