Transition to Adult Care Symposium Boston, MA April 27, 2012 Richard C. Antonelli, MD, MS Assistant Professor of Pediatrics Medical Director of Integrated Care

Transition –You mean from hospital to nursing home? Consensus Statement (2002) Find adult providers willing to care of these youth –Rotate –Buy them gifts

New Consensus Statement with algorithm Increasing collaborations between pediatric and adult provider organizations Increasing interest from academia Development and promulgation of tools

ACA –Eligibility for insurance Triple Aim Value Optimization –Quality –Cost

For CYSHCN, age 12 ‐ 17 years only: 1.The youth’s doctor has discussed each of the following with him/her (or parent indicated that such discussions were not needed): - Transitioning to doctors who treat adults - Changing health needs as youth becomes an adult - How to maintain health insurance as an adult 2. Doctor usually or always encourages the youth to take age ‐ appropriate responsibility for managing his or her own health needs Measure endorsed by the National Quality Forum (NQF)

Identify patients meeting criteria for care coordination –Medical Home Matters PCP-based Subspecialty-based –Collaborative Care Models Care Coordination Case management –Look for ways to reduce costs Unplanned readmissions ED utilization for ambulatory sensitive conditions Population-based approach

VocationEducation AdultPediatrics PCP SP Youth, Family, “Circle of Support”

Population: Patients w/ sickle cell disease Outcomes to drive value –QoL –Graduation rates –Employment status –Cost by sector Activities which support Care Coordination (CCMT) EDImaging In-patientAmbulatory PharmacyPCP and SP

Define “Episode of Care” Time-Related –Service provision from 18 th to 19 th birthday Preventive services – care guidelines Episodic services – evidence-based Patient-focused education Financing– bundled; pmpm; FFS; global –Care Coordination –Risk adjustment

Focus on Optimizing Value –Identify and track clinical outcome measures Condition-specific Process and structure measures are NOT sufficient Create innovative, sustainable models of collaborative care –Focus on co-management and TME Short and longer term savings critical ACO structure –Define the population –Attribution may be challenge– or opportunity