Case Study: Nationwide Children’s Hospital: An Accountable Care Organization Going Upstream to Address Population Health

Abstract

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Insights Results

Overview of case study

In an effort to aid MCOs and ACOs in the early stages of population health strategy development, the Nemours Foundation has set out to spotlight outstanding systems that provide examples of success and demonstrate the flexibility that may be available under existing Medicaid managed care authorities. One such system is Nationwide Children’s Hospital (NCH); by further understanding NCH’s experience in upstream investment, this study aims to illuminate pathways for other MCOs and ACOs to focus on social determinants in their population health strategy

NCH is a large academic medical center in Columbus, Ohio, with more than 1 million patient visits per year and 25,000 inpatient admissions. NCH also co-owns a pediatric ACO called Partners for Kids (PFK) and carries full financial risk for about 330,000 children in the Medicaid program. While not focused on obesity prevention, PFK implements an upstream population health strategy using predominantly Medicaid funding that may be widely applicable to many disease prevention efforts including childhood obesity

As PFK took on more risk by serving more Medicaid children who were now enrolled in managed care, it became apparent that to further improve outcomes and save money in the long run, NCH needed to invest in upstream population health activities that addressed social determinants of health. This signaled a shift from population management for their patient panels to population health for a geographically defined population. NCH, through PFK, began working to address the upstream, nonclinical needs of the geographic population to improve downstream clinical outcomes

A number of lessons can be drawn from NCH’s experience of prioritizing partnerships and long-term funding strategies to positively affect population health. The following is a set of strategies MCOs and ACOs should consider as they work toward population health improvement: 1) Understand internal leadership priorities and passions because most leaders have pet issues they care deeply about; 2) Align aspirations with external power brokers such as political, business, and community leaders to contribute to long-term success; 3) Move from isolated projects to long-term strategy by targeting services needed in the community and targeting high-cost populations with interventions that affect upstream determinants for those populations; 4) Measure progress through shared metrics and set of tools to track progress/successes; and 5) Build sustainable relationships through internal champions and thoughtful partners