HealthVine Overview
HealthVine Weaves New System for Children's Health
Gardeners plant vines for their tenacity and ability to thrive by weaving through rocks, over trellises and around poles. A vine cannot stand on its own, yet it becomes so strong that it resists bending or breaking.
Cincinnati Children’s HealthVine, like the plants its name suggests, took root in 2021 in the unforgiving soil of a global pandemic. Its values—continuous improvement, impact, collaboration—were the fertilizer that allowed it to take root and grow to manage the physical and mental health of more than 135,000 children and young adults during calendar year 2021.
This annual report describes how HealthVine—launched in partnership with CareSource, the largest Medicaid managed care organization in Ohio—established itself and how it is poised to grow from Southwest Ohio to become a nationally recognized leader in pediatric accountable care.
The Seeds of Accountable Care
Before HealthVine, there was the Health Network by Cincinnati Children’s (HNCC), a community-based network of providers both inside and outside the medical center. The network was responsible for managing the care of Medicaid-eligible children in Southwest Ohio enrolled in two insurance plans.
Membership size was not sufficient to sustain HNCC, but within two years, CareSource approached Cincinnati Children’s with a managed care delegate proposition. The opportunity was timely.
Cincinnati Children’s, in preparation for its 150th anniversary in 2033, set a goal to transform child health and care delivery through integrated research, education, innovation, advocacy, and family and community partnerships. The slogan for the expansive strategic plan is “Pursuing our Potential Together.”
Becoming a managed care delegate for CareSource presented Cincinnati Children’s with an extraordinary opportunity to pursue its 2033 goal by overseeing the care of a population ripe for new approaches to improve their health prospects today and for the future, while simultaneously reducing overall healthcare costs.
“Cincinnati Children’s has set our sights on ensuring that Cincinnati is home to the healthiest children in the nation. We will pursue our potential together so that all children can pursue theirs. As part of Pursuing Our Potential Together, we launched HealthVine, a Pediatric Accountable Care Organization.”
Evie Alessandrini, MD, MSCE, chief operating officer, Cincinnati Children's Hospital Medical Center
The HealthVine-CareSource Partnership
Starting on Jan. 1, 2021, HealthVine became responsible for the healthcare and health outcomes of about 135,000 CareSource Medicaid-covered youth living within Adams, Brown, Butler, Clermont, Clinton, Hamilton, Highland, and Warren counties. Members include:
- Youth ages 0-19
- Youth and young adults up to age 21 in the Aged, Blind and Disabled (ABD) program
- Youth and young adults up to age 21 in the Adopted and Foster Child program
HealthVine By the Numbers
The illustrations show the breakdown of HealthVine membership by county of residence, race, ethnicity and other categories. All figures are as of Dec. 31, 2021.
HealthVine Population by County of Residence
Hamilton
Butler
Clermont, Warren, Highland, Clinton, Brown, Adams
Of the 131,962 members on the HealthVine census at the end of 2021, 75% of members live in either Hamilton or Butler County, more urban and suburban locales. The remaining 25% of members are spread across Clermont, Warren, Highland, Clinton, Brown, and Adams counties.
HealthVine Population by Age
0-5 Year Olds
6-10 Year Olds
11-15 Year Olds
16-21 Year Olds
The HealthVine population is comprised of members ranging from newborns to members up to age 21 who are enrolled in the Aged, Blind, and Disabled (ABD) and Adopted and Foster Care programs.
HealthVine Population by Race and Ethnicity
White
Black or African American
Asian, Middle Eastern, Native Hawaiian and Pacific Islander, American Indian and Alaska Native, and Other
Non-Hispanic
Hispanic
HealthVine serves a diverse member population within the Southwest Ohio region and works to ensure equitable care, service, and support for all members.
And Behind the Numbers
The children under HealthVine’s care are some of the most vulnerable—medically, emotionally, and socially. Claims for 2021 services showed that the highest costs were incurred for the treatment of members with:
- Asthma
- Depression
- Congenital heart disease
- Premature birth
- Complex conditions that make them depend on equipment or technology such as implanted devices, feeding tubes, or respirators.
Members of the Medicaid population can be profoundly affected by social determinants of health; examples of social determinants include economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
The children and youth HealthVine support are at risk for having more gaps in care—fewer checkups and immunizations, for example—and the care they receive can often be fragmented and uncoordinated.
Social determinants also affect how well children with chronic conditions, such as asthma or diabetes, can adhere to treatment and medication routines prescribed to manage their conditions. This can result in frequent use of the emergency department and greater frequency of hospitalization and readmission when compared to children with greater advantages.
Altogether, these factors lead to higher healthcare costs, poor-quality health outcomes, and children with futures compromised by poor physical and mental healthcare.
“HealthVine is a unique approach to balancing quality healthcare with cost effectiveness. HealthVine strives to improve care and outcomes while reducing the cost of care.”
Jeff Anderson, MD, MPH, MBA, senior vice president and chief population health officer, Cincinnati Children's Hospital Medical Center
Organization and Operations
Many Cincinnati Children’s leaders, staff, and departments—particularly Payor Relations, Finance, Legal, and Information Services—were instrumental in launching HealthVine. They also continue to support the five HealthVine programs started in 2021 and the Research and Innovation program launched in mid-2022.
“Our team draws from talent and expertise across Cincinnati Children’s and our community. We are experienced in managed care and work directly with providers, stakeholders and community organizations to support children in our region.”
Kim Kaas, MBA, PMP, vice president, population health operations, Cincinnati Children's Hospital Medical Center
Care Management supports the coordination of members’ care among providers, from primary care and specialist practices to hospitals and community-based partners in children’s health and welfare. The team is comprised of registered nurses, social workers, and community health workers who have experience and training to support HealthVine members with chronic and acute physical and behavioral health concerns.
Utilization Management evaluates the medical necessity of provider requests for medical and surgical inpatient, outpatient and behavioral health services which require prior authorization under the members’ insurance plan. The team offers best-practice solutions for the delivery of medically appropriate care and is also involved in advocating for changes to administrative rules and policies that affect children throughout Ohio.
Behavioral Health addresses the most widespread and challenging issues in child and young adult health today. Through an extensive range of activities, the Behavioral Health program supports connecting members to care, advances evidence-based treatment, and works toward increasing the availability of behavioral healthcare in Southwest Ohio.
Community Engagement connects healthcare providers and other organizations—from community benefit organizations to school systems—to HealthVine and its many programs and services. Providers benefit from opportunities for education and information on critical issues in children’s health as well as HealthVine resources and tools that will help them improve the quality of care they provide to their patients and clients.
Quality Improvement and Data Analytics focuses on issues and conditions that have far-reaching effects on child and adolescent population health and healthcare costs. It organizes and helps support teams to investigate the root causes of and potential solutions for operational and clinical population improvement opportunities.
Research and Innovation uses the data on children’s health that HealthVine gathers to develop pilot projects for testing new approaches, evaluating the outcomes, and sharing the insight gained with healthcare providers throughout the region and potentially the country.
“Everyone who works in HealthVine just has an energy and enthusiasm to do what’s best and what’s right for kids. Everyone is very open and team-oriented. And I think that is what really leads to our success.”
Ndidi Unaka, MD, MEd, medical director, HealthVine Quality Improvement and Data Analytics
HealthVine Grows Its Mission
“Coming together is a beginning; keeping together is progress; working together is a success” is attributed to 19th-century author Edward Everett Hale. In 2021 and the first half of 2022, HealthVine came together, seeded programs to improve children’s health, and worked to make those programs real.
Detailed information about the activities of the core operational programs is included in this annual report. So, too, is a window into what HealthVine is working on in 2022 and its ambitions for the years ahead.