Cincinnati Children’s partners with CareSource to create a coordinated care model

Agreement between hospital and health insurer focuses on improving outcomes for patients, reducing the overall cost of healthcare

Tuesday, December 08, 2020

Cincinnati Children’s has contracted with the nonprofit health insurance company CareSource with the goal of improving health and outcomes for thousands of children in Southwest Ohio who rely on Medicaid.

Starting Jan. 1, 2021, Cincinnati Children’s and CareSource will launch a collaboration aimed at improving care for 125,000 Medicaid-covered children currently enrolled in CareSource who reside in eight counties in Southwest Ohio. Under this collaboration, Cincinnati Children’s will assume accountability for care management and utilization management for these children.

Cincinnati Children’s has developed the HealthVine network to support the effort. HealthVine will work in close collaboration with community and hospital-based providers to coordinate care and support services for children and their families in Hamilton County as well as the counties of Adams, Brown, Butler, Clermont, Clinton, Highland and Warren.

The care management team at Cincinnati Children’s HealthVine will partner with providers to support optimal health and wellness outcomes for patients. In addition, HealthVine care managers will support high-risk children and adolescents who have significant social and medical complexity.

HealthVine also will help Cincinnati Children’s and CareSource study the population and identify clinical effectiveness management opportunities, which will reduce the overall cost of healthcare by prioritizing preventive care for children.

Cincinnati Children’s is committed to partnering with CareSource and the community to ensure the most vulnerable children get the care they need in the right setting and at the most appropriate level. That will include partnerships with Federally Qualified Health Centers and city health department clinics as well as private community pediatricians to better integrate care.

The network is designed to ensure children can access primary care as well as behavioral health services, said Mona Mansour, MD, a pediatrician at Cincinnati Children’s who is HealthVine’s medical director for community engagement.

“The partnership is a great opportunity to elevate outcomes for pediatric patients,” Mansour said. “It leverages the pediatric expertise that Cincinnati Children’s Hospital has for care delivery, quality improvement, and even bringing new discoveries in care to patients in the community with the expertise and knowledge of a managed care company like CareSource.”

One of the state’s largest health insurers, CareSource manages benefits for children enrolled in Medicaid plans in Ohio.

“CareSource is committed to providing value-based care to ensure children receive the seamless support needed, especially during these complex times,” said Steve Ringel, CareSource Ohio Market President. “Our collaboration with Cincinnati Children’s will only continue to help improve the lives of children in Southwest Ohio.”

CareSource has partnered with other pediatric hospital systems to create separate networks across Ohio. The company provides health benefits for nearly 670,000 Ohio children. CareSource aims to make population improvements through greater levels of integration and improved health care outcomes.

“Working collaboratively with our provider partners enables the strengths of both organizations to be combined and further our shared goal of providing first-class health care to the children in our communities, thus improving not only their health but also the quality of their lives,” said James Voiland, PhD, chief clinical officer for CareSource.

Cincinnati Children’s HealthVine is a network of pediatric and other care providers and organizations that connect to help children be healthier. The network will provide value to practices via care management and care coordination support, Epic-based tools to support care management and population management, quality improvement tools, as well as data and analytics on shared outcome measures.

HealthVine will be fully integrated across the Cincinnati Children’s Hospital Medical Center, creating strong partnerships with internal teams for care management, data, quality, finance and information services to guide better patient outcomes.