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Transforming Care Delivery: Regional Collaboration for Washington's kids


By Angela Riley, MD, FAAP, Pediatric Medical Director, Molina Healthcare of Washington
By Michael Dudas, MD, FAAP, President, Washington Chapter of the American Academy of Pediatrics
By Kathleen Clark, Community Healthcare Improvement and Linkages, Washington State Department of Health

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Original Publish Date: August 9, 2016

As health care leaders, we share a common goal and responsibility to improve care delivery and ultimately the health of our communities. Arguably the most effective resources we depend on to sustain our population’s health and spark change in the health care system are the primary care provider teams who care for children and adolescents across the state.

Toward that end, the Washington Chapter of the American Academy of Pediatrics is partnering with the Washington State Department of Health and Molina Healthcare of Washington to offer primary care providers and behavioral health practices that care for kids an opportunity to be part of a pediatric practice transformation network. The three organizations are collaboratively working together after successfully securing a $16 million grant from the Centers for Medicare and Medicaid Services (CMS) to fund system changes in pediatric practices across the state.

Molina, Washington’s largest Medicaid health plan, is serving as the lead managed care organization in this effort. Grant-related performance data (quality and cost) will be based on services rendered to children assigned to a pediatric primary care provider (pediatrician or family practice physician) who participate in Molina’s comprehensive, statewide provider network.

This is a unique and unprecedented opportunity for clinicians to join a program that will help them with data-based assessments of their practices to prioritize clinical areas of focus, set goals, and determine metrics to benchmark improvement in measurable health outcomes. Participation will also support providers in developing sustainable business operations to drive performance success in preparation for the state’s Healthier Washington initiative, which includes moving most providers to some form of "value-based care" reimbursement by 2019.

Transforming Clinical Practice Initiative

The Transforming Clinical Practice Initiative (TCPI) is the largest grant ever awarded for clinical improvement at the federal level. The four-year initiative, from the Center for Medicare and Medicaid Services, will support the transformation of 140,000 clinicians across the United States through 29 Practice Transformation Networks (PTNs). Washington is home to one of only two PTNs in the country focused solely on pediatrics (0-20 years of age).

Why children?

While we know that investments in children’s health pay off in adulthood, outcomes data indicate that our state is currently lagging behind the nationwide average in well-care services delivered to children. The recently published, 2015 Community Checkup Report ("Report"),1 illuminated a number of significant opportunities to improve care delivery to Washington’s children and build a foundation for lifetime health and wellbeing. Key findings in the Report indicate low Washington state scores for childhood immunizations rates, access to primary care, and child health screenings.

Why Join?

The Pediatric-Transforming Clinical Practice Initiative (Pediatric-TCPI) is intended to transform care delivered to children by working with a network of 5,600 clinicians and their care teams to provide family-centered and cost-effective care for 350,000 children by September 2019. Regional physician champions, practice facilitators and behavioral health champions, will provide local mentorship and support to practices participating in the initiative. Clinical measures will focus on:

Initiatives like the Pediatric-TCPI demonstrate a commitment to statewide collaboration to improve the delivery of health care and move toward system transformation. We are confident that we will ultimately accomplish our shared goal of improving health outcomes for our children, and realize the vision of a Healthier Washington.

Clinicians interested in joining us in this effort to improve the health of kids in our state can learn more at http://pediatrictcpi.org/.

1 www.wacommunitycheckup.org/Media/Default/Documents/community_checkup_report_2015.pdf?AspxAutoDetectCookieSupport=1