Annual Evaluation of Florida’s Partners in Care: Together for Kids Program

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Information about Annual Evaluation of Florida’s Partners in Care: Together for Kids Program

Published on October 19, 2007

Author: nashp

Source: slideshare.net

Description

Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: Caprice Knapp

Annual Evaluation of Florida’s Partners in Care: Together for Kids Program A Children’s Hospice International Program for All-Inclusive Care for Children and Their Families (CHI PACC ® ).

Describe Florida’s CHI PACC ® program Discuss ICHP evaluation methodology Show results from the evaluation Lessons learned Overview

Describe Florida’s CHI PACC ® program

Discuss ICHP evaluation methodology

Show results from the evaluation

Lessons learned

A Pediatric palliative care program for children with potentially-life limiting conditions. PIC:TFK is modeled after Children’s Hospice International’s integrated model, Program for All-Inclusive Care for Children ( CHI PACC ® ) What is PIC:TFK?

A Pediatric palliative care program for children with potentially-life limiting conditions.

PIC:TFK is modeled after Children’s Hospice International’s integrated model, Program for All-Inclusive Care for Children ( CHI PACC ® )

What is PIC:TFK? First government subsidized pediatric palliative care program in the U.S. Services started July 2005 Partnerships: Florida Hospices and Palliative Care Children’s Medical Services Network (Title V Agency) Agency for Health Care Administration (Medicaid Agency) CMSN AHCA Hospice ICHP

First government subsidized pediatric palliative care program in the U.S.

Services started July 2005

Partnerships:

Florida Hospices and Palliative Care

Children’s Medical Services Network (Title V Agency)

Agency for Health Care Administration (Medicaid Agency)

What is PIC:TFK? 9 sites Limited to 940 Medicaid children 150 Title XXI Children must be 0-21 years of age Children must be certified annually by PCP as having a potentially life-limiting condition.

9 sites

Limited to 940 Medicaid children

150 Title XXI

Children must be 0-21 years of age

Children must be certified annually by PCP as having a potentially life-limiting condition.

In 2000, Florida was one of 5 states funded by appropriations to develop a PACC® Model Program. States were initially encouraged to submit a 1115 Research and Demonstration Waiver. In 2004, federal CMS and CHI recommended that states submit 1915 Program Waivers. In June 2005, PIC:TFK services were approved and added to the Florida’s Managed Care Waiver 1915(b). The Waiver extends over 2 years. PIC:TFK History

In 2000, Florida was one of 5 states funded by appropriations to develop a PACC® Model Program.

States were initially encouraged to submit a 1115 Research and Demonstration Waiver.

In 2004, federal CMS and CHI recommended that states submit 1915 Program Waivers.

In June 2005, PIC:TFK services were approved and added to the Florida’s Managed Care Waiver 1915(b).

The Waiver extends over 2 years.

PIC:TFK In Home Services Pain and Symptom Consultation Nursing Care Therapeutic Counseling for Child and Family Art, Music, Play Therapies for Child and Family In-home and Inpatient Respite Personal Care Bereavement Support & Volunteer Services* *Non reimbursed

Pain and Symptom Consultation

Nursing Care

Therapeutic Counseling for Child and Family

Art, Music, Play Therapies for Child and Family

In-home and Inpatient Respite

Personal Care

Bereavement Support & Volunteer Services*

*Non reimbursed

What diagnoses will children have? HIV/AIDS Cancer Chromosomal disorders Congenital defects or anomalies Hematological abnormalities Metabolic disorders Trauma Muscular dystrophy Neurodegenerative disorders Other (Co-Morbidities)

HIV/AIDS

Cancer

Chromosomal disorders

Congenital defects or anomalies

Hematological abnormalities

Metabolic disorders

Trauma

Muscular dystrophy

Neurodegenerative disorders

Other (Co-Morbidities)

Who may benefit from Palliative Care? Newly Diagnosed Stage: Children diagnosed within the first 3 months and who may/may not be in curative care. Mid Stage: Children who are 4 months or more post-diagnosis and who are on active treatment and/or intervention. End of Life Stage: Children who are 4 months or more post-diagnosis and who are not responding to a normal course of treatment/interventions for their diagnosis and future options are limited.

Newly Diagnosed Stage: Children diagnosed within the first 3 months and who may/may not be in curative care.

Mid Stage: Children who are 4 months or more post-diagnosis and who are on active treatment and/or intervention.

End of Life Stage: Children who are 4 months or more post-diagnosis and who are not responding to a normal course of treatment/interventions for their diagnosis and future options are limited.

Year 1 Evaluation Activities SURVEYS ICHP developed & fielded: Survey for parents and children Hospice survey based on EQRO federal requirements SITE VISITS Attended site visits with CMS headquarters

SURVEYS

ICHP developed & fielded:

Survey for parents and children

Hospice survey based on EQRO federal requirements

SITE VISITS

Attended site visits with CMS headquarters

Enrollment trends

PIC Enrollment Trends 27% of the Medicaid enrollment slots are filled* 80% of enrollees are in stage 2, and 10% are in both stages 1 and 3 91% are Title 19, 7% Title 21, and 2% Safety-Net Leading diagnoses are: Brain Injury/development Congenital Anomaly MD HIV CP *As of April 2007

27% of the Medicaid enrollment slots are filled*

80% of enrollees are in stage 2, and 10% are in both stages 1 and 3

91% are Title 19, 7% Title 21, and 2% Safety-Net

Leading diagnoses are:

Brain Injury/development

Congenital Anomaly

MD

HIV

CP

*As of April 2007

Barriers to Enrollment Bias from nurses and physicians Some diagnoses are not consistently referred (HIV) Lack of understanding about palliative care Enrolled versus Actively Enrolled Similar programs in the community

Bias from nurses and physicians

Some diagnoses are not consistently referred (HIV)

Lack of understanding about palliative care

Enrolled versus Actively Enrolled

Similar programs in the community

Recommendations to Increase Enrollment ICHP produces a diagnostic driven potential enrollment list Training of nurses Formal screening tool is needed Adjust enrollment to reflect active enrollees Address systematic referral inconsistencies (HIV)

ICHP produces a diagnostic driven potential enrollment list

Training of nurses

Formal screening tool is needed

Adjust enrollment to reflect active enrollees

Address systematic referral inconsistencies (HIV)

Barriers for Hospice Enrollment may not justify new staff Adequate staff needed to provide all services Not all sites provide full complement of PIC services Billing issues

Enrollment may not justify new staff

Adequate staff needed to provide all services

Not all sites provide full complement of PIC services

Billing issues

How PIC:TFK Families Learned About the Program Nurse care coordinator 52%, Provider 16%, Brochure 5%, Friend or family member 8%, Social service agency 6%, Hospital 11%, and Other 23%.

Nurse care coordinator 52%,

Provider 16%,

Brochure 5%,

Friend or family member 8%,

Social service agency 6%,

Hospital 11%, and

Other 23%.

Parent Reported Services that PIC:TFK Children Have Received Support counseling 61%, Music therapy 30%, Art therapy 11%, Play therapy 9%, Pain and symptom management 15%, Personal care 15%, and Nursing care 54%.

Support counseling 61%,

Music therapy 30%,

Art therapy 11%,

Play therapy 9%,

Pain and symptom management 15%,

Personal care 15%, and

Nursing care 54%.

Length of Time From Enrollment to Receipt of Services

Satisfaction with PIC:TFK Benefits

Consumer Assessment of Health Plans

Parent Survey Recommendations Agents other than nurse care coordinators should play a larger role in referrals Investigate why time of invitation/receipt of services varies Evaluate the service benefit package for effectiveness Try and speak with children/teens about their experiences

Agents other than nurse care coordinators should play a larger role in referrals

Investigate why time of invitation/receipt of services varies

Evaluate the service benefit package for effectiveness

Try and speak with children/teens about their experiences

Contact Information: Caprice Knapp, PhD [email_address] Vanessa Madden, BsC [email_address] Elizabeth Shenkman, PhD [email_address]

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