Tools for Coordinating Care: Scoring Intensity and Complexity

This section provides tools to assist in the coordination of care at the practice, community, and state level.

The following tools are categorized by the type of care coordination/ case management program in which they are generally used. A complexity score for each identified child will help providers/staff prepare and budget time more effectively for each child. It will also help administrators justify essential extra time spent by the practice in the care and support of the children and their families.¹

Practice Base Care Coordination
• Exeter Pediatrics "Homes" Complexity Scale & Complexity Index (Phoenix Pediatrics) David Hirsch, MD | Chapel Hill Pediatrics and Adolescents, PA
  Complexity Scales: to identify the level of complexity/intensity involved in supporting children with special health care needs in your practice.
  
  
• Special Needs Risk Factor Scale (Guidelines)
  The Scale was explicitly designed to include psychosocial risks since the developers experiences indicated that for many providers, the psychosocial issues were more difficult to handle in the primary care setting than the medical conditions. They also negotiated an agreement with their county Medicaid managed care plan to pay a risk-adjusted primary care capitation rate to pediatricians (and now family physicians) serving children who reach a threshold score of 4 points on the Scale. Their Medical Home Project encourages medical home practices to attend the Risk Factor Scale training and to participate in the risk-adjusted capitation program.
  
  

  " It's a win-win: Primary care physicians (PCPs) identify both medical and psycho-social risks in their patients, which enhances their ability to serve as medical homes to these kids and their families, and PCPs serving children with moderate or high needs (as determined by the Scale) get more money from the plan. We have responded to PCP feedback (through surveys we've conducted over the years) and made some changes in the Scale, and we collaborate with the plan to analyze the data from the Scales to determine what other steps we should take to assist PCPs and families." - Alameda County Medical Home Team

  
  State Case Management Program
• Colorado's system for determining the level of care coordination (CC)
  They have 3 levels of CC: 1.) Resource information available for those initially coming in, 2.) Minimal, short-term CC, and 3.) Individual CC involved with families.
  They are also looking at reimbursement with #3 through contracts with a local HMO and some work with Department of Human Services.
  
  
Using Enrollment, and Claims or Other Encounter Level Data
• Summary Description of Clinical Risk Groups (CRGs);
  National Association of Children's Hospitals and Related Institutions -2000
  Clinical Risk Groups (CRG's) is a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition using enrollment, and claims or other encounter level data. The commercial software for CRGs has been developed by 3M Health Information Systems. (4 pages)

1. Exeter Pediatrics "Homes" Complexity Scale. © Center for Medical Home Improvement 2001.

Last updated July 28, 2006