Pediatric ACO scores a success for Medicaid kids

An Ohio pediatric accountable care organization (ACO) serving a Medicaid population has achieved a lower cost-rate increase than Medicaid fee-for-service and managed care providers while maintaining or improving quality of care on both federal measures and internal goals, a new study reports.

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Researchers examined changes in the cost and quality of care from 2008 to 2013 at Partners for Kids (PFK), a 760-physician ACO sponsored by Nationwide Children’s Hospital in Columbus that serves more than 300,000 low-income children in central and southeastern Ohio. They gathered comparative cost histories from statewide Medicaid records for fee-for-service and managed care providers. To evaluate quality of care, they used 15 pediatric quality indicators from the Agency for Healthcare Research and Quality (AHRQ) and 4 indicators targeted by PFK.

At baseline in 2008, PFK’s per-member-per-month cost was $108.53 (for approximately 3.5 million member-months per year), $67.03 lower than fee-for-service providers and $23.75 lower than managed care. Partners for Kids’ costs grew at a rate of $2.40 per year compared with $16.15 per year for fee-for-service and $6.47 per year for managed care.

When the researchers compared quality-of-care indicators for 2008-2010 with indicators for 2011-2013, they found improvement in 5 of the AHRQ measures (including 2 composite measures), declines in 3, and no significant change in the remaining indicators. Modest improvements were seen in gastroenteritis admission rate, pediatric quality acute composite, and pediatric overall composite; declines occurred in diabetes short-term admission rates and perioperative hemorrhage or hematoma rates.

Of the 4 internal quality targets-days spent in the neonatal intensive care unit (NICU), asthma-related emergency department visits, rate of well-child visits for 3- to 6-year-olds, and hemoglobin A1c levels in diabetic children-2 measures (days in the NICU and well-child visits) showed improvement; the others remained unchanged.

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Partners for Kids “has demonstrated part of the vision behind pediatric ACOs by reducing costs while maintaining quality of care,” thereby improving the value of care for Medicaid children, the researchers write. They suggest that PFK’s success with the ACO model may derive from the greater ability of pediatric ACOs to bridge gaps in coordinating care compared with individualized patient-centered medical homes or insurers.

Pediatric ACOs may offer an effective model for health care reform, “at least for Medicaid,” the researchers note, but improving and measuring quality of care remains challenging. Partners for Kids will participate in testing a proposal for accreditation and quality measurement of ACOs that is under development by the National Committee for Quality Assurance.