transition to adult care symposium boston, ma april 27, 2012 richard c. antonelli, md, ms assistant...
TRANSCRIPT
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Transition for Youth from Pediatrics to Adult Systems of Care:What is Different in 2012?
Transition to Adult Care SymposiumBoston, MA
April 27, 2012
Richard C. Antonelli, MD, MSAssistant Professor of Pediatrics
Medical Director of Integrated Care
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Speaking of Transition…
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Transition 2005
• Transition– You mean from hospital to nursing home?
• Consensus Statement (2002)
• Find adult providers willing to care of these youth– Rotate– Buy them gifts
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Transition 2011
• New Consensus Statement with algorithm
• Increasing collaborations between pediatric and adult provider organizations
• Increasing interest from academia
• Development and promulgation of tools
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Transition 2012
• ACA– Eligibility for insurance
• Triple Aim
• Value Optimization– Quality– Cost
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What Do We Currently Measure?
For CYSHCN, age 12‐17 years only:
1. The youth’s doctor has discussed each of the following
with him/her (or parent indicated that such discussions
were not needed):
- Transitioning to doctors who treat adults
- Changing health needs as youth becomes an adult
- How to maintain health insurance as an adult
2. Doctor usually or always encourages the youth to take
age‐appropriate responsibility for managing his or
her own health needs
Measure endorsed by the National Quality Forum (NQF)
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How Much Progress Are We Making?Or, Why Aren’t We?
www.childhealthdata.org
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Impact by Type of Special Needs
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Impact of Emotional, DB Issues
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Role of Medical Home
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Disparities
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Opportunities
• Identify patients meeting criteria for care coordination– Medical Home Matters
• PCP-based• Subspecialty-based
– Collaborative Care Models• Care Coordination• Case management
– Look for ways to reduce costs• Unplanned readmissions• ED utilization for ambulatory sensitive conditions• Population-based approach
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Relationships
• Vocation• Education
• Adult• Pediatrics
PCP PCP
SPSP
Youth, Family, “Circle of Support”
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Example
• Population: Patients w/ sickle cell disease
• Outcomes to drive value– QoL– Graduation rates– Employment status– Cost by sector
• Activities which support Care Coordination (CCMT)
ED Imaging
In-patient Ambulatory
Pharmacy PCP and SP
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Patient with Sickle Cell Disease in Transition
• Define “Episode of Care”
• Time-Related– Service provision from 18th to 19th birthday
• Preventive services – care guidelines• Episodic services – evidence-based• Patient-focused education
• Financing– bundled; pmpm; FFS; global– Care Coordination– Risk adjustment
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What Must We Do Right Now?
• Focus on Optimizing Value– Identify and track clinical outcome measures
• Condition-specific• Process and structure measures are NOT sufficient
• Create innovative, sustainable models of collaborative care– Focus on co-management and TME
• Short and longer term savings critical• ACO structure
– Define the population– Attribution may be challenge– or opportunity