Fostering Health NC Working to Improve Health Outcomes for Infants, Children, Adolescents and Young Adults in Foster Care Adam Svolto, MPA Program Director, Fostering Health NC Leslie Starsoneck, MSW Consultant, Fostering Health NC October 23, 2014 The Foster Population: Challenges Poor Health Outcomes • Disproportionately high rates of physical, dental, and mental health problems • Designated by AAP as Children and Youth with Special Health Care Needs Complicated • Disruption in living arrangements = inaccurate/incomplete medical records • Consent to treat/release of information requests—who can authorize? High Cost • Costs for the foster care population are three times those of the non-fostered Medicaid population The Seven Components of a Medical Home Accessible Family-Centered Continuous Comprehensive Coordinated Compassionate Culturally Competent Fostering Health NC (FHNC): Background • Collaborative, multidisciplinary effort • Fostering Connections to Success and Increasing Adoptions Act of 2008 • Initial training using readiness assessments: March 2013 FHNC: Background New Hanover County Pilot Study, 2012-2013 • Embedded LCSW at Wilmington Health • Access to CCNC Provider Portal/Close coordination with New Hanover DSS • Increased periodicity compliance/Reduced ER utilization • Cost savings of $200 PMPM within nine months FHNC: Current Work Mission: Measurable improvements in health outcomes for NC foster population. Led by North Carolina Pediatric Society • Grant partners include CCNC and NC Center of Excellence for Integrated Care • Funded by Children’s Health Insurance Program Reauthorization Act (CHIPRA) FHNC Approach • Based on AAP Standards of Care for children and youth in foster care • Informed by research that shows that the medical home model, coupled with care coordination, improves health care for children in foster care and reduces costs • Policy development led by FHNC and 40-member advisory team • Technical assistance FHNC: Current Work State Advisory Team Work Groups • • • • • Training DSS Forms Pharmacy/Medication Management Health Passport Outcomes American Academy of Pediatrics National Initiative, built on Fostering Connections Legislation 2008 www.aap.org/fostercare - Background, standards, sample forms • • • • Initial Visit within 72 hours focused on acute care needs Comprehensive Visit within 30 days of placement Follow-up Well-Visit within 60-90 days of placement Ongoing Well-Visits based on the child’s age: • Visits monthly: 0-6 months old • Visits every 3 months: 6-24 months • Visits twice per year: 2-21 yrs old By definition, children & youth in foster care meet criteria for Children and Youth with Special Health Care Needs (CYSHCN) FHNC Approach: The Three-legged Stool This approach supports the best outcomes for the foster care population. Children in foster care require significant coordination, attention to their special health care needs, and an understanding and attention to social behavioral needs and the impact of trauma. Medical Homes for Children in Foster Care Local DSS CCNC Network Primary Care Clinician CC4C – partnership among CCNC, DPH, DMA Optimizing the Medical Home Model Leveraging Technology • CCNC Informatics Center Provider Portal (foster care = Medicaid eligible) • Improve information flow/health records continuity/decision-making Sharing Information • Best Practices: Medical home/AAP Standards/Medicaid codes/Screening tools • ROI/Social Services Information Changing Processes • Technical assistance and consultation • Health Summary Forms/Letter of Agreement Template/TECCA Informing Policy • Clarify HIPAA restrictions • Improve NC Juvenile Code • “Health Passport” FHNC Online Library—Tools and Resources www.ncpeds.org/foster-care-medical-home Technology-Enabled Care Coordination Agreement (TECCA) • Pathway for counties to access CCNC Provider Portal • Provider and care team contact information • Office and hospital visit histories (w/diagnoses) • Medications and prescriptions/compliance • Immunizations Best Practices Documents • DSS Social Workers • CCNC Network Staff/Care Managers • Providers • Parents FHNC Online Library—Tools and Resources www.ncpeds.org/foster-care-medical-home Letter of Agreement Template (similar to MOU) Health Summary Forms in fillable PDF format (one for each type of visit) • Combines elements from DSS Forms 5243 and 5244 • Organizes information needed to support different visit types • May be uploaded to Provider Portal (CCNC/CC4C) Memo: Sharing Health Information for Treatment (UNC School of Government) Memo: Sharing Social Services Information FHNC Anticipated Outcomes Success Indicators--CCNC report by county/primary care practice • • • • AAP-recommended well-child periodicity compliance Decreased ER utilization Decreased hospitalization Reduced overall PMPM cost FHNC Anticipated Outcomes Estimated Annual Cost Savings • $10.8M at 50 percent program implementation • $16.2M at 75 percent program implementation • $21.6M at 100 percent program implementation Efficiency Gains • Time savings: forms completion, ROI requests • Provider-led medical home model Going Forward Implementing the Fostering Health NC Model • Strengthen your partnership with the local CCNC network and medical homes • Establish a Letter of Agreement • Ensure AAP Standards of Care for the Initial Visit, Comprehensive Visit, Well Visit • Adopt revised Health Summary Forms • Leverage CCNC Provider Portal to capture/preserve critical health information • Enter a Technology-Enabled Care Coordination Agreement with CCNC (see TECCA FAQ) • Engage CCNC to assist you with county-level population management • Ask your CCNC Quality Improvement (QI) Specialist for quarterly roll-up reports Questions? Adam Svolto: 919-673-2768 / [email protected] Leslie Starsoneck: 919-624-3487 / [email protected] Leigh Poole: 919-839-1156 / [email protected] http://www.ncpeds.org/foster-care-medical-home
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