Partners for Kids, one of the nation’s largest pediatric accountable care organizations (ACO), had lower cost growth than did Medicaid fee-for-service and managed care programs in Ohio from 2008 to 2013, without reducing overall quality of care, according to an observational, retrospective study published Feb. 9 in Pediatrics.
Accountable care organizations have been shown to reduce costs for adults without negatively impacting quality of care; however, there’s been little proof before now that the model works for children.
The per-patient/per-month cost increase for Partners for Kids (PFK), which covers more than 300,000 low-income children in central and southeastern Ohio, was $2.40/year from 2008 to 2013, vs. $16.15/year for the Ohio Medicaid fee-for-service program (P = .001) and $6.47/year for Ohio Medicaid managed care programs (almost statistically significant at P = .121).
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Results on key quality measures were mixed. Slight improvements were seen over that time in PFK’s gastroenteritis admissions, pediatric acute care, and pediatric composite scores, as well as reduced neonatal ICU admissions and increased well-child visits. However, modest increases were seen in short-term admissions for diabetes and perioperative hemorrhages and hematomas (Pediatrics 2015 Feb. 9 [doi:10.1542/peds.2014-2725]).
Overall, the care differences were a wash; quality measures held fairly steady over the 5 years.
“PFK delivered on the promise of the ACO. ... We suggest that the PFK model achieved these results because pediatric ACOs are better positioned to bridge coordination gaps in care than either an individualized patient-centered medical home or an insurer could do alone; the ACOs are, in effect, the medical neighborhood for the medical home,” said lead author Kelly Kelleher, vice president of health services research at the Research Institute at Nationwide Children’s Hospital and professor of pediatrics at Ohio State University, both in Columbus. “At least for Medicaid, pediatric ACOs may be efficient models of reforming health care. The lower rate of cost growth achieved by PFK bodes well for the short-term success of PFK’s business model and other pediatric ACOs,” said Dr. Kelleher.
Most PFK pediatricians are employees of Nationwide Children’s Hospital. Those who aren’t keep a percentage of their Medicaid fees over cost as an incentive. Also, Ohio’s Medicaid managed care plans pay PFK a monthly capitation fee based on their patients’ age and sex, and PFK keeps whatever they don’t spend on their patients.
The system seemed to work in the study because “PFK is able to provide a single set of provider guidelines for common conditions, a single set of collaborative activities for clinicians, and unified care coordination with pediatric specialty teams. As a physician/hospital organization, PFK is also more directly involved in the specialty care than a typical insurance company and can provide a unified voice on coordination and guidelines,” Dr. Kelleher said.