Driscoll Health Plan, a subsidiary of Driscoll Children’s Hospital in Corpus Christi, Texas, contracted to take on a new, value-based Medicaid managed care plan for indigent, disabled children next year before the state has decided what it will pay. The payer also will have to sign contracts with physicians months before it knows the rates for STAR Kids, the pediatric component of the State of Texas Access Reform Plus (STAR+Plus) program that takes effect in the fall of 2016.
“It’s a signature of faith,” said Driscoll Health Plan CEO Dr. Mary Dale Petersen. It also means that Driscoll will have to be efficient and effective at coordinating care.
Driscoll will be working closely with the physician community in the 24 counties — covering 25,000 square miles — of its service area in South Texas to make sure families have proper care plans and that primary care physicians have communication with hospital emergency departments in the name of care continuity.
Petersen knows that health information exchange will be central to the effort, even though it has been “problematic,” in South Texas and beyond. “We will be working through our portals,” she said. Nurses will have to sign off on care plans within the portal.
And there will be a lot of nurses. The STAR Kids contract will brings 17,000 new members into the health plan, so Driscoll expects to hire at least 260 new people, including about 200 nurses and social workers, and set up dedicated call centers.
These will be high-risk members. The Star KIDS partnership is focusing on medically complex children who qualify for Supplemental Security Income disability benefits, as well as emotionally disturbed and medically dependent children, Petersen said. “The whole goal is to make sure these children are not institutionalized,” she said.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
According to the Children’s Hospital Association, children with medical complexities encompass 6 percent of youth enrolled in Medicaid nationally, but account for 40 percent of spending.
Driscoll has brought in Valence Health, a consulting and technology firm serving healthcare organizations in risk-based payment models, to develop its alternative payment system. Chicago-based Valence just hired its first senior vice president of pediatrics, Dr. Tim Johnson, two weeks ago.
“Change can be scary for some people,” Petersen said. “We need to create the messaging and the staffing to provide the handholding” that many new members and their families will need.
Valence also is building out the payer’s claims system for long-term care. These claims look different from standard hospital or physician claims.
Additionally, Driscoll is partnering with Texas A&M University-Corpus Christi to develop a comprehensive assessment for patients in their homes that considers social and environmental factors, Petersen said. Driscoll will be deploying tablets to its nursing corps to conduct the assessments in hopes of being more efficient and capturing better data.
“It’s a yearlong process to get it right,” Petersen said.
Photo: Flickr user Texas State Library and Archives Commission
