$1.4B in expenses

Member health care service partners for kids (PFK) acts as an accountable care organization and is committed to providing and improving medical care for children enrolled in managed medicaid and living in the south central, south east, and west central (10 counties) regions of ohio. It has full-risk capitation agreements with the 4 medicaid managed care plans and is financially responsible for the medical, dental, vision and pharmacy claims expenses for approximately 475,000 children. PFK works closely with hospitals, physician practices and medicaid managed care plans to ensure comprehensive and quality medical care is available to the medicaid population within its service area.

$8.6M in expenses

Care navigation partners for kids care navigation provides both episodic and complex case management based on patient needs, intensity of service required, and level of care. The goals of care navigation program are: a. Assist patients in achieving optimum health outcomes, functional capability, and quality of life through improved management of their disease or condition. B. Identifying, accessing and maximizing available benefits and resources. C. Assist patients in achieving goals by improving their ability to self-manage their disease or condition. D. Coordinating services among providers involved by creating collaboration between patients, family, providers, and community organizations to develop goals. E. Facilitating timely receipt of appropriate services in the most appropriate setting. Partners for kids' care navigation conducts semi-annual program evaluations which measure: a. Reduction in utilization - testing of select patients demonstrates a significant reduction in inpatient admissions, bed days, and ed visits. B. Outreach engagement rates by population type - 2021 patient outreach resulted in 47.9% enrollment. C. Satisfaction survey results - composite score mean on patient survey regarding integrated care is 67.9 for 2021.

$5.8M in expenses

Quality improvement, community health & research quality improvement coaching - partners for kids quality improvement coaching program concentrates on key issues affecting children's health, and is tailored to participating community primary care and behavioral health providers in a 34-county region. Practices are supported on-site by a PFK quality strategist or quality consultant who coaches practice teams through projects, shares ideas for change and tests changes. The improvement process at the community primary care practice or behavioral health organization is then supported by participation in a diverse network where best practices and challenges are shared. Improvement is measured using objective definitions, often based on hedis measures prioritized by the ohio department of medicaid, and statistical tools to support decision making. In 2021, the partners for kids quality improvement coaching program: a. Engaged 40 community practices with at least one active qi project during the year, with 125,514 partners for kids patients receiving care at those sites - of these engaged practices, nearly half of them (17) participated in more than one active project in 2021 - three of these practices participated in three or more different projects b. Engaged six community behavioral health organizations with at least one active qi project during the year - two of these engaged behavioral health organizations participated in both quality improvement projects offered c. Facilitated 69 active qi projects with community providers, including: - 6 asthma projects - 8 depression projects - 3 emergency department reduction projects - 7 fluoride varnish projects - 2 immunization projects - 9 reproductive health projects - 26 well visit projects - 3 patient engagements projects - 4 follow up after hospital discharge for behavioral health condition projects - 1 antipsychotic prescribing project d. Showed improvement in nearly half of active qi projects in primary care practices and behavioral health organizations e. The PFK qi coaching team also supported the development of a sister quality improvement coaching program in the west central region of PFK, which encompasses 10 additional counties, through project portfolio development, data analysis and quality improvement training. The partners for kids office of the medical director hosts a project echo learning collaborative around the delivery of behavioral health care in the primary care setting. Project echo is a hub and spoke model, with a multidisciplinary team including psychology, psychiatry, primary care pediatrics and a network specialist serving as the hub team, and community based primary care providers as the spokes. Using short didactics and participant led case presentations and discussions, project echo aims to increase the comfort and competence of primary care providers in managing patients with behavioral health concerns. The topics for the weekly sessions include a wide range of both foundational learning and deeper dives into the most prevalent pediatric behavioral health conditions. This office has also developed specific prescribing guidelines for the most prevalent behavioral health conditions in youth and is supporting community providers with webinar educational sessions and in-person consultation with pharmacists with relevant expertise. School-based health centers and mobile units - the school-based health program is a partnership with central ohio schools that is designed to reach patients with the greatest need. The program is co-funded by nationwide children's hospital and partners for kids and managed by nationwide children's hospital. The 14 school-based health centers (SBHC) and 2 mobile units provide unique access to primary care for those not otherwise accessing care. Providers in these clinics and mobile units integrate care with services provided in schools, community sites and also reconnect patients to a medical home. A primary goal of the school-based health centers and mobile units is to reduce health inequities for an at-risk population of students. Secondarily, the aims include: reducing preventable school absences, increasing the number of children receiving preventative care, improving outcomes for students with chronic medical conditions and reducing physiological and environmental factors that impede academic attainment. Important measures of this program include: a. The school health team played a vital role in covid-19 vaccine distribution to children, providing 21,608 vaccines, reaching children with barriers to access to the vaccine. B. The SBHC staff completed 5,857 patient visits and the mobile team completed 1,464 visits. 2,633 of these total visits were well checks. C. The clinic staff submitted 1,115 referrals, with the most common being behavioral health and ophthalmology, and dental clinic referrals. D. In 2021, the mobile units served 44 unique sites. These sites were a combination of schools, early childhood centers and community locations. School-based asthma therapy (sbat) program -the school-based asthma therapy (sbat) program works as a liaison between the school and the asthma care provider to design a plan for students with high-risk asthma to receive his/her asthma prevention medication right at school. One of the primary goals of the program is to maintain the student's asthma care with their asthma care provider, while helping improve compliance of the student's asthma care with their controller medications. Working with community partners, such as the school nurse to help children get their medicine makes this possible. The program is co-funded by nationwide children's hospital and partners for kids. A. There were 508 unique students enrolled in sbat by the end of the 2021-22 school year from 241 participating schools. B. When comparing patient outcomes 1 year pre- and 1 year post-sbat enrollment, the following results were achieved: - a 52% reduction in ed rates - a 73% reduction in ip rates - a 78% reduction in picu rates research - partners for kids' data is used to support research. We believe that research enables PFK to: a. Uphold our responsibility to improve the quality and efficiency of care for children; b. Support measures population health; c. Enable clinicians to develop, evaluate and lead improvement interventions research productivity is measured by the use of PFK in articles published in peer-reviewed journals and used in scholarly poster presentations. In 2021, PFK participated in eight peer-reviewed publications and 1 oral presentation at a regional conference.