295 - A Novel Methodology for Creating Risk-Adjusted Value Based Pathways for Pediatric Patients

Publication Number: 295.3910

Stanley J. Weinberger, UVM Children's Hospital, Burlington, VT, United States; Francisco Corbalan, Robert Larner, M.D., College of Medicine at the University of Vermont, Middlebury, VT, United States; Michelle Cangiano, Robert Larner, M.D., College of Medicine at the University of Vermont, Hinesburg, VT, United States; Jason Revoir, The University of Vermont Children's Hospital, Burlington, VT, United States; Keith J. Robinson, The University of Vermont Children's Hospital, Williston, VT, United States

Background: Pediatric primary care medical homes care for patients with increasing medical and social complexity. A robust methodology to characterize that complexity could help in panel size management, staffing and scheduling to more proactively meet patient needs. There are not validated methodologies to do this in pediatrics. The Pediatric Medical Complexity Algorithm (PMCA) is a methodology for classifying children with chronic disease, however it was validated in hospitalized children and does not account for social complexity.

Objective: Develop an algorithm in pediatric primary care to classify children by medical and social complexity to direct team-based care towards patient needs.

Design/Methods: A multidisciplinary team across the University of Vermont Health Network (UVMHN) developed a methodology that built on the PMCA and adult value based care (VBC) pathways developed at the institution. Patients were classified into six pediatric VBC pathways using diagnosis factors, utilization factors, and health related social needs. An iterative process was used to initially validate and refine the algorithm. Pediatric primary care providers were surveyed regarding current panel complexity and satisfaction. Assumptions were made around engagement rate, visit frequency and duration by age and VBC pathway. Based on those assumptions, calculated panel sizes per provider full-time equivalent (FTE) were compared with current observed panel size per FTE.

Results: The six VBC pathways include: Well-being (1), Primary care managed (2), Specialty care (3), Complex polychronic (4), Longitudinal social/developmental needs (5), and Serious illness (6). UVMHN has five pediatric primary care practices with 27 providers and 20,582 patients. Patient numbers decreased across VBC pathways except pathway 5. Total calculated panel size was 7 percent smaller than observed panel size per FTE, with 80 percent of providers with observed to expected panel sizes between 0.5 and 1.7. Providers were split in whether their current schedule and team allowed them to appropriately manage the complexity of their panel, but overwhelmingly agreed that this effort was an important step.

Conclusion(s): The pediatric VBC algorithm was able to sort patients across six unique conceptual groups based on social and medical complexity. It identified large variation among panel size per FTE, and by shifting panels to be more equal, may allow for better access and continuity for primary care providers.

Description and Criteria for Pediatric Value Based Care Pathways


Number of Patients per Value Based Care Pathway
The six VBC pathways include: Well-being (1), Primary care managed (2), Specialty care (3), Complex polychronic (4), Longitudinal social/developmental needs (5), and Serious illness (6)

Observed to Expected Panel Size per Provider
Provider number denotes individual pediatric primary care providers in the health network.