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Fostering Health NC
Working to Improve Health Outcomes for Infants, Children,
Adolescents and Young Adults in Foster Care
Adam Svolto, MPA
Program Director, Fostering Health NC
Leslie Starsoneck, MSW
Consultant, Fostering Health NC
October 23, 2014
The Foster Population: Challenges
Poor Health Outcomes
• Disproportionately high rates of physical, dental, and mental health problems
• Designated by AAP as Children and Youth with Special Health Care Needs
Complicated
• Disruption in living arrangements = inaccurate/incomplete medical records
• Consent to treat/release of information requests—who can authorize?
High Cost
• Costs for the foster care population are three times those of the non-fostered
Medicaid population
The Seven Components of a Medical Home
Accessible
Family-Centered
Continuous
Comprehensive
Coordinated
Compassionate
Culturally Competent
Fostering Health NC (FHNC): Background
• Collaborative, multidisciplinary effort
• Fostering Connections to Success and Increasing Adoptions Act of 2008
• Initial training using readiness assessments: March 2013
FHNC: Background
New Hanover County Pilot Study, 2012-2013
• Embedded LCSW at Wilmington Health
• Access to CCNC Provider Portal/Close coordination with New Hanover DSS
• Increased periodicity compliance/Reduced ER utilization
• Cost savings of $200 PMPM within nine months
FHNC: Current Work
Mission: Measurable improvements in health outcomes for NC foster population.
Led by North Carolina Pediatric Society
• Grant partners include CCNC and NC Center of Excellence for Integrated Care
• Funded by Children’s Health Insurance Program Reauthorization Act (CHIPRA)
FHNC Approach
• Based on AAP Standards of Care for children and youth in foster care
• Informed by research that shows that the medical home model, coupled with care
coordination, improves health care for children in foster care and reduces costs
• Policy development led by FHNC and 40-member advisory team
• Technical assistance
FHNC: Current Work
State Advisory Team Work Groups
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Training
DSS Forms
Pharmacy/Medication Management
Health Passport
Outcomes
American Academy of Pediatrics
National Initiative, built on Fostering Connections Legislation 2008
www.aap.org/fostercare - Background, standards, sample forms
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Initial Visit within 72 hours focused on acute care needs
Comprehensive Visit within 30 days of placement
Follow-up Well-Visit within 60-90 days of placement
Ongoing Well-Visits based on the child’s age:
• Visits monthly: 0-6 months old
• Visits every 3 months: 6-24 months
• Visits twice per year: 2-21 yrs old
By definition, children & youth in foster care meet criteria for Children and Youth
with Special Health Care Needs (CYSHCN)
FHNC Approach: The Three-legged Stool
This approach supports
the best outcomes for the
foster care population.
Children in foster care
require significant
coordination, attention to
their special health care
needs, and an
understanding and
attention to social
behavioral needs and the
impact of trauma.
Medical
Homes for
Children in
Foster Care
Local
DSS
CCNC
Network
Primary
Care
Clinician
CC4C – partnership among
CCNC, DPH, DMA
Optimizing the Medical Home Model
Leveraging Technology
• CCNC Informatics Center Provider Portal (foster care = Medicaid eligible)
• Improve information flow/health records continuity/decision-making
Sharing Information
• Best Practices: Medical home/AAP Standards/Medicaid codes/Screening tools
• ROI/Social Services Information
Changing Processes
• Technical assistance and consultation
• Health Summary Forms/Letter of Agreement Template/TECCA
Informing Policy
• Clarify HIPAA restrictions
• Improve NC Juvenile Code
• “Health Passport”
FHNC Online Library—Tools and Resources
www.ncpeds.org/foster-care-medical-home
Technology-Enabled Care Coordination Agreement (TECCA)
• Pathway for counties to access CCNC Provider Portal
• Provider and care team contact information
• Office and hospital visit histories (w/diagnoses)
• Medications and prescriptions/compliance
• Immunizations
Best Practices Documents
• DSS Social Workers
• CCNC Network Staff/Care Managers
• Providers
• Parents
FHNC Online Library—Tools and Resources
www.ncpeds.org/foster-care-medical-home
Letter of Agreement Template (similar to MOU)
Health Summary Forms in fillable PDF format (one for each type of visit)
• Combines elements from DSS Forms 5243 and 5244
• Organizes information needed to support different visit types
• May be uploaded to Provider Portal (CCNC/CC4C)
Memo: Sharing Health Information for Treatment (UNC School of Government)
Memo: Sharing Social Services Information
FHNC Anticipated Outcomes
Success Indicators--CCNC report by county/primary care practice
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AAP-recommended well-child periodicity compliance
Decreased ER utilization
Decreased hospitalization
Reduced overall PMPM cost
FHNC Anticipated Outcomes
Estimated Annual Cost Savings
• $10.8M at 50 percent program implementation
• $16.2M at 75 percent program implementation
• $21.6M at 100 percent program implementation
Efficiency Gains
• Time savings: forms completion, ROI requests
• Provider-led medical home model
Going Forward
Implementing the Fostering Health NC Model
• Strengthen your partnership with the local CCNC network and medical homes
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Establish a Letter of Agreement
• Ensure AAP Standards of Care for the Initial Visit, Comprehensive Visit, Well Visit
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Adopt revised Health Summary Forms
• Leverage CCNC Provider Portal to capture/preserve critical health information
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Enter a Technology-Enabled Care Coordination Agreement with CCNC (see TECCA FAQ)
• Engage CCNC to assist you with county-level population management
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Ask your CCNC Quality Improvement (QI) Specialist for quarterly roll-up reports
Questions?
Adam Svolto: 919-673-2768 / adam@ncpeds.org
Leslie Starsoneck: 919-624-3487 / lstarsoneck47@gmail.com
Leigh Poole: 919-839-1156 / leigh@ncpeds.org
http://www.ncpeds.org/foster-care-medical-home