Value-Based Care Delivery: HealthVine

Ensuring children live healthier lives by delivering care more effectively and affordably

Value-Based Care Delivery works to provide excellent and equitable care for all patients in our primary service area (and perhaps beyond) and to do so in the most cost-effective ways. This includes leveraging value-driven contracting through HealthVine, our pediatric accountable care organization. The strategic goals for Value-Based Care delivery are listed below.

Expand Value-Based Contracting
Improve Outcomes
Drive Affordability
Care System Redesign
Increase the number of children for whom we are accountable by increasing the number of covered lives in a value-based financial contract
Optimize care delivery for patients with the most expensive conditions, including closing equity gaps in care and outcomes
Improve the cost of care and utilization by developing new risk prediction models, including focus on the most expensive conditions, then using these models to drive care delivery system innovation
Focus on delivering the right care in the right way in the right place (close to home) for families in support of the Health Equity Network

Key Highlights

HealthVine was focused on operational improvements, strategic realignments, and quality-driven outcomes. This year, HealthVine enhanced alignment and excellence through:

  • New Payors for Care Management: Expanded partnerships with additional payors to support care management services
  • Epic Tapestry for Utilization Management: Streamlined processing of requests for prior authorizations through Epic Tapestry
  • Team Realignment: All RN primary care and inpatient care management teams now report through Mary Burton, senior clinical director for HealthVine Care Management, aligning programs, enhancing collaboration, and optimizing workflows
  • Quality and Performance Improvement (QAPI): Completed utilization management QAPI review, which informed area evaluation
  • OhioRISE: Partnered with local behavioral health organizations to provide insightful data to inform Mobile Response and Stabilization Services, Intensive Home-Based Treatment, and Respite service growth in underserved areas to improve access

HealthVine Membership

HealthVine serves the following counties in Southwest Ohio, with the majority of our members in Hamilton county.

HealthVine Members

Members enrolled in HealthVine Care Management

Members engaged in HealthVine OhioRISE Care Coordination

HealthVine Engagement

The HealthVine Care Management, Utilization Management, and OhioRISE teams make a substantial impact on HealthVine members, as highlighted in the numbers below.

HealthVine Care Management

Member outreaches

57% increase from 2023

Health Risk Assessments (HRAs)

58% increase from 2023

Members enrolled in Care Management

106% increase from 2023

HealthVine Utilization Management

Cases reviewed in 2024

Cases reviewed in Epic Tapestry

Turn-Around Time compliance

HealthVine OhioRISE

Member engagement rate

Flex fund dollars used to support OhioRISE members

Members engaged in HealthVine OhioRISE Care Coordination

Strategic Plan Delivery Achievements

  • Tripled monthly enrollment rate for HealthVine Care Management
  • Improved documentation and achieved 95% success rate in chart audits conducted by Managed Care Organizations (MCOs)
  • Saved costs and decreased emergency department utilization through the use of Tytocare (remote exam device) and CincyKids Health Connect (virtual urgent care)
  • Increased access to critical behavioral health resources through HealthVine OhioRISE program

Looking Forward

In 2025, HealthVine is focusing on:

  • Growing and expanding with new payor partners to serve more Medicaid members in our region
  • Expanding targeted outreach to increase adherence to well-child visit guidelines
  • Partnering on quality initiatives with other Ohio accountable care organizations to enhance care management member outcomes
  • Increasing care management enrollment through tracking data and generating innovative initiatives
  • Completing re-certification for National Committee for Quality Assurance (NCQA) in care management and utilization management

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