For Physicians

More than 1,000 doctors in 34 counties in central and southeast Ohio Medicaid regions participate in Partners For Kids. With assistance from those partnership doctors, PFK programs have led to steady or improving measures of quality care and patient outcomes, such as:

  • Asthma patient visits to the emergency department decreased almost every month in 2015 from comparable months in 2012-2014.
  • The number of days patients with certain neurologic diagnoses, such as children with cerebral palsy who also have a feeding tube, spent in the hospital per month dropped significantly from the beginning of 2011 to the end of 2014.

View the PFK Network Providers Directory  (as of April 9, 2017).

Programs and Benefits

PFK member practices receive several advantages:

Physician Incentive Program

Our incentive program makes quarterly payments based on quality measures, including:

  • A premium over Medicaid rates with each adjudicated claim.
  • A bonus for each patient who achieves pre-established quality outcomes, including well-child visits.
  • A share in the cost savings that result from a focus on prescribing patterns for select drug categories. Our staff pharmacists can assist with prescribing guidelines.

Pharmacy Program

PFK pharmacists provide guidelines to physicians who may be unaware that some medications are less expensive, more effective or more widely covered by health plans than others. The pharmacy program works with the Medicaid Managed Care Plans to give patients better access to certain treatments that the plans do not already cover, and provides information that allows the plans to save money even outside of PFK.

Practice Facilitation of Quality Improvement

The quality improvement coaching and support program works with your office to provide on-site support and assist practices in achieving improved outcomes. Practices select from a list of issues to make their focus. That list includes:

  • Asthma
  • Behavioral health
  • Health supervision visits
  • Emergency department avoidance
  • Fluoride varnish
  • Patient experience
  • Reproductive health

A PFK quality improvement specialist will come on-site to help guide the projects. The team and the quality improvement specialist will meet regularly to share ideas for change and test changes. The improvement process at the practice is then supported through participation in a learning network in where diverse practices share best practices.

Through this evidence-based approach, practices participating in similar programs have experienced success in increasing delivery rates of preventive services and improving relationships, communication, and efficiency among staff and providers.

Member Outreach

To help you earn incentive dollars, PFK can provide personnel to contact your patients who have not been seen recently and schedule them for a well-child appointment.

Our staff can work in your office to:

  • Schedule patients or work closely with your schedulers, depending on your preference
  • Send an outreach letter to families with children due for their well-child services. Using your practice’s letterhead and stationery, we will print letters on your behalf; or, if you prefer to handle the mailing, we can reimburse your practice for postage expense.

Care Navigation

Care coordinators assist children with medical complexity and their families to navigate uneventfully, efficiently and as effectively as possible through the health care system.

Delegated Credentialing

We provide credentialing for all five Medicaid managed-care plans and most of the large commercial plans.

Claims Resolution

Our staff is ready to assist you with resolving claims issues with the five Medicaid managed-care plans.

Electronic Medical Record Implementation

Working with information technology experts within Nationwide Children’s, we can assist in implementing a new eClinicalWorks EMR and a related Health Information Exchange.

 

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