Frances Chalmers, MD, FAAP
Trustee, Washington Chapter of the American Academy of Pediatrics
Chair, WCAAP Health Care Transformation Committee
September 30, 2019 marked the end of the four-year Pediatric Transforming Clinical Practice Grant led by the Washington State Department of Health, with significant support from WCAAP and Molina. The project was extremely successful and productive, resulting in the enrollment of 121 medical practices comprised of 800 Pediatrician/ARNP/PAs and 92 Behavioral Health Clinics with 1000 BH Providers. These clinicians received dedicated support from a Regional Practice Facilitator, a Regional Physician Champion and a Regional Behavioral Health Champion. Serial Practice Assessment tools encouraged and informed each practice to track their progress in moving along the Practice Transformation continuum. Many clinics “graduated” to Value-Based contracting by the end of the grant.
Four day-long Population Health Forums offered nationally renowned keynote speakers and a broad variety of interactive workshops around varied aspects of population health and clinical transformation. Eighteen in-person trainings on behavioral health were provided in several regions of the state (with funding from Amerigroup for depression screening trainings). Webinars with regional presenters on key transformation topics were recorded for those unable to call in for the live events, including a series on behavioral health topics.
Practices were supported financially to improve community relationship-building between medical and behavioral health settings as an early step towards clinical Behavioral Health Integration. Data was provided quarterly for the practices’ Molina panels to aid in learning about empanelment, data extraction, and gap analysis resulting in many clinics being able to substantially increase their well-child care and immunization rates.
P-TCPI learnings helped inform a workgroup including WCAAP members and staff and HCA, and informed by a national expert with experience in pediatric value-based payment to explore the development of a pediatric-specific value-based payment approach for Washington State. This work has highlighted the need for acknowledging the value but also importantly the cost of providing Integrated Behavioral Health Services and Patient- and Family-Centered Care Coordination to address Social Determinants of Health and ACES within the Pediatric Medical Home.
On a personal note, as an example, Skagit Pediatrics Clinic in Mount Vernon is one of the many practices that benefited from P-TCPI. For our clinic the timing was perfect as the partners were just embarking on Patient Centered Medical Home Certification and at the same time looking for funding and training for implementing an integrated behavioral health provider. The tremendous training support from P-TCPI and the training and financial support as a North Sound Regional Accountable Community of Health Partner made it possible for Skagit Pediatrics to learn the skills necessary to achieve PCMH Certification, succeed with a small venture into Value Based Contracting, and to hire a clinically integrated licensed social worker. In recent months, our social worker has kept a teen or two out of the ER, provided short term psychotherapy to kids who would not otherwise have accessed the needed care, and the clinic has started to collect the necessary data to support the ROI for Care Coordination and BHI support for children at risk due to not just medical complexity but due as well to social risk factors.
PTCPI has ended but the learning continues and the WCAAP’s Practice Transformation Committee has within its four-year goals a commitment to support practitioners by continuing to identify and prioritize improvements which will foster long term returns in child health outcomes.