2. Overview
Introduction to CPC
Mission and Vision
Core Model Components
Current Health Initiatives
Respiratory Initiative
Immunization Initiative
Healthy Living Initiative

3. Colorado Pediatric Collaborative
• Colorado Pediatric Collaborative (CPC), Inc. is a nonprofit
partnership between:
– Colorado Pediatric Partners (CPP), an
Independent Physician Association of pediatric
practices located along the front range of Colorado;
– Physician Health Partners (PHP), a large
healthcare management services organization; and
– Children’s Hospital Colorado, the leading provider
of inpatient, sub-specialty, and emergent care to
children in the Rocky Mountain west

4. CPC Board Leadership
• Joan Bothner, MD - Chairman
• Andrew Bauer, MD – Vice Chairman
• Jeff Harrington – Secretary/Treasurer
• Monica Federico, MD
• Robert King, MD
• Michael Narkewicz, MD
• Stephanie Stevens, MD
• Holbrook Stapp, MD
• Lisa Wetherbee

5. CPP PCP Practices
• Advanced Pediatric Associates
• Arvada Pediatrics
• Aspen Park Pediatrics
• Centennial Pediatrics
• Child Health Clinic
• Children’s Medical Center
• Crown Point Pediatrics
• Denver Pediatrics
• Evergreen Pediatrics
• Greenwood Pediatrics
• Guardian Angels Health Center
• Kids First Pediatrics
• Morarka Pediatric Office
• Mountainland Pediatrics, P.C.
• Office of Drs. Fleischaker &
Khayut
• Partners in Pediatrics
• Peak Pediatrics, PLLC
• Pediatrics 5280
• Pediatrics at the Meadows, P.C.
• Pediatrics West
• Red Rocks Pediatrics, P.C.
• Rocky Mountain Pediatrics, P.C.
• Stapleton Pediatrics

6. Colorado Pediatric Collaborative
• As of September 2014, the CPC network consists of:
– 23 practices
– 120 pediatricians
– 200,000 pediatric patients in the Denver Metro area
• CPC is the first organization of its kind in the Denver area
combining the expertise of a hospital, primary care
physicians, specialists and a medical management
company to improve the overall quality of care for the
children and families they serve

7. CPC Vision and Mission
• Vision
– Improve the health of children and families through innovative
partnerships and clinical models that create an integrated system of care
• Mission
– Develop collaborative partnerships across care settings to allow for
effective, efficient, high-quality healthcare
– Incorporate a patient-centered philosophy that is focused on value and
efficiency
– Demonstrate value and quality outcomes through the implementation of
robust, evidence-based medicine and rigorous analysis of program
effectiveness to determine impact and adjust as appropriate
– Serve as a leader in the development and testing of innovative care and
reimbursement models that reward quality and value
– Align program and payment strategies with the Triple Aim and
demonstrate accountability with respect to quality, cost, and patient
experience

8. CPC Accomplishments
• Procured $1.5M Start-up Grant from CO Health Foundation—Expires
2015
• Brought Together Three Independent Parties to Address the
Regional Opportunity to Improve Care for Colorado’s Children!
• Developed and implemented innovative health initiatives in the
primary care setting
• Procured Two Major Provider Contracts from Anthem and Aetna
Affecting 23 Practices!

9. Triple Aim

10. CPC Model Components
• Evidence-Based Guidelines & Clinical Education
– Education and training from physician experts
• Clinical Quality Improvement
– Assessment
– Improvement Team
– Training
– Implementation
– Evaluation and Improvement
• Health Information Technology & Data Analytics
– Registries
– Electronic Health Records and Health Information
Exchange
– Data analysis and reporting

11. Health Initiatives
Respiratory
Immunizations
Healthy Living
Mental Health
Special Needs

12. Respiratory Initiative
• Asthma initiative was implemented in 2007 across all
practices
– Adherence to evidence based guidelines
– Process measures: Severity assessment, controller meds,
influenza
– Outcome measures: ED and urgent care, hospitalizations, missed
work and school
– Registry-based tool designed to improve guideline compliance

13. Background and Research Objective
Study Design and Methods
Principal Findings
Conclusions
Authors: Monica J Federico, MD 1
, Sara Deakyne, BS, MPH 1
, R. Holbrook Stapp, MD 3
, Britta Fuglevand, MS2
, and Lalit Bajaj, MD, MPH 1
.
1
Pediatrics, University of Colorado, Aurora, CO, United States; 2
Physician Health Partners, Denver, CO, United States and 3
Colorado Pediatric Collaborative, Denver, CO, United States.
Improving Asthma Care in a Community Pediatric Independent Practice Association
through Academic/Community Collaboration
Relevance to policy, delivery
or clinical practice
• Many children have poorly controlled asthma despite national
guidelines for the diagnosis and management of asthma.
• Significant barriers exist in the implementation of evidence-based
guidelines into community practice. Strategies addressing these barriers
require multi-stakeholder investment and are difficult to coordinate
• Our objective was to assess the long term impact of a community and
academic partnership to implement asthma quality improvement in an
independent practice association (IPA) of community pediatricians.
In 2006, pulmonologists from the Breathing Institute of Children’s
Hospital Colorado worked with Colorado Pediatric Partners, an
Independent Physician Association, to create an asthma care quality
improvement program. This was an observational study of that
program.
Population: The IPA consists of 23 practices/173 providers and serves
over 160, 000 children. Inclusion criteria: children over 5 years of age
with a provider diagnosis of asthma. Exclusion criteria: Children with
lung disease of prematurity, cystic fibrosis, cardiac anomalies,
neuromuscular disease.
Intervention:
1.Practice redesign and quality improvement curriculum provided by
practice coaches assigned to each practice.
2.Case-based asthma education at each practice by a pulmonologist
3.Asthma care tools including intake forms, action plans, electronic
health record integration
4.Asthma registry on a separate server with web-based data entry
5.Regular data reporting on demand and scheduled and provided by one
of the 3 full time practice coaches at least quarterly
6.Negotiations with payers to support the asthma care program.
7.American Board of Pediatrics approval of the program for MOC.
Analysis: Children with at least two visits in the registry were included in
the analysis. Proportions and means were calculated for demographics
and process outcomes. Rates were calculated for hospital admissions,
ED/UC visits, missed school days and missed work days. Associations
with other factors, including age, payer, whether the patient saw a
specialist, use of inhaled steroids, asthma teaching and smoke exposure
were analyzed using repeated measures Poisson regression.
• Implementing a standardized approach to asthma
care leads to sustained improvement in process and
health outcomes across a large population of
children with asthma
• Medicaid patients’ care and outcomes improved but
those patients were still more likely to have ED/UC
visits, missed days of work and missed days of
school than privately insured
• Continuous process improvement with the
appropriate staffing model can lead to sustained
improvement in the health outcomes for children
with asthma
• A community/academic partnership that combines
asthma education, process redesign, and a registry
based tracking system, can improve the care
delivered to pediatric patients and can improve
health outcomes for those patients. The program
design also allows for the continuous assessment of
gaps in care, and areas that require special
attention and more focused intervention.
• Health care policy should encourage government
and private payers to help fund the infrastructure
that is necessary for providers, practices, and
systems to improve health outcomes
Total patients 1908
Total visits 9,923
2 or more
provider
surveys
1789
2 or more
patient surveys
1615
Mean visits per
patient
5
Total patient
days
406,149
Mean Age
12.5 years
(range: 5-25)
% Male 59%
% Private
insurance
72%
Targ
et
2008/2
009
(n=1,8
90)
2011/20
12
(n=1,88
2)
Persistent
asthma
̶ 61% 61%
Severity
assessment
completed
90% 100% 100%
Asthma action
plan
60% 69% 90%
Flu shot 90% 91% 95%
Persistent and
on controller
medication
90% 78% 85%
Demographics Process Outcomes
• Grant support: Colorado Health Foundation
• Acknowledgments: Physician Health Partners, Colorado
Pediatric Collaborative, Dan Hyman, MD, Joan Bothner,
MD
Hospital Admits and ED/UC
Visits
Health Outcome
Change in Risk
From 2008/09 to
2011/12
95%
Confidence
Interval
p-value
Hospital
Admission*
-69% -36%,-85% p=0.0014
ED/UC** -62% -40%,-76% p<0.0001
Missed School ŧ
-47% -27%,-61% p<0.0001
Missed work days ŧŧ
-39% -24%,-39% p<0.0001
Adjusted Outcomes Analysis
(All patient reported)
* Adjusted for age, asthma education in the office, smoke exposure, specialist
involvement, inhaled steroid use
** Adjusted for age, specialist, inhaled steroid use, and payer
Adjusted for age, specialist, inhaled steroid use, smoke exposure and payerŧ
Adjusted for age, specialist, steroid use and payerŧŧ
Missed School and Missed
Work
Note: Among participating practices, 98.6% of
patients in the registry have a visit in 2011/2012.
Funding and Acknowledgments

14. Immunizations Initiative
• Immunization initiative was implemented in 2009 across
all practices
– Adherence to evidence based guidelines
– Process measures: HEDIS Childhood Immunization
Measure for 2 yr. olds and 13 yr. olds
– CPC practices use the Colorado Immunization
Information System (CIIS) to electronically track
immunization status and history for patients
– CPC estimates that 95% of its entire population is
affected by this initiative

15. Healthy Living Initiative
• Target Population
Patients 2-18 years of age
– Subset population
» Patients with BMI 85-94% with risk factors
» Patients with BMI 95%ile≥
Phase 1 Measures:
BMI Percentile,
Blood Pressure Screening,
Counseling for Nutrition,
Counseling for Physical Activity

16. Healthy Living Initiative
Long Term Goals
• Improve adherence to nationally
accepted guidelines and
performance measures
• Reduce costs to the health care
system associated with preventable
co-morbidities and exacerbations
due to obesity
• Improve caregiver confidence in
managing a healthy lifestyle action
plan
Program Goals
• Identify children who are at risk of
becoming obese or are obese
• Provide counseling on nutrition and
physical activity to children who are
not currently at risk as to maintain
their health status
• Help children who are obese build
healthy lifestyles and improve
health outcomes through
community wide patient centered
intervention
• Provide physicians with the tools to
effectively manage obese patients
in the primary care setting

17. Mental Health & Special Needs
• Collaborative approach with community organizations to
support primary care providers and patients
– Current areas of focus:
• Colorado Psychiatric Access and Consultation for Kids (C-
PACK)
• Transition Clinic through the Special Care Clinic at CHCO
• CPC will continue to explore collaborative opportunities to
improve quality of care for patients

18. CPC Strategic Opportunities
• Expand the Number of CPC Practices & Pediatricians
• Gain Greater Acceptance of the Electronic Medical Record and the Value-
Added Data Submission for Analysis within the Pediatric Community
• Introduce a Comprehensive Asthma Registry
• Respond to the Need for Enhanced Practice Tools
• Acquire and Implement Better Software Tools for Managing & Reporting on
Disparate Patient Data
• Identify Emerging Trends and Improvement Opportunities in Children’s
Medicine in CO.
• Reduce the Cost of Care!
• Expand Our Philanthropic Support Base!
• Identify Synergistic Community Collaborators

19. CPC-The Next Phase
• Address the Immediate Need to Secure $1.5-2M in New Funding
Support for 2015-2016
• Pursue Grant Scaling on the CHF Commitment
• Establish Sophisticated IT Platform and Address CORHIO
Opportunity
• Expand Coaching and Direct Support-Outreach to Practices
• Continue Building Community Based Support Hybrid Foundation and
Government Grants
• Ensure Alignment with Pediatric Needs and Concerns
• Continue to Disseminate “Best-Practice Approaches to Prevalent and
Costly Pediatric Conditions

20. Why Invest in CPC?
• CPC is Addressing a Serious, Societal
Healthcare Need in a Responsible Manner
• CPC Members Have Voluntarily Committed to
Ensuring CO Children Have the Best Care
• CPC Brings Together Three Recognized
Healthcare Entities Working Collaboratively
Toward Efficiency and Efficacy in Medicine
• CPC Members Have Invested in Improving Care
and Seek Community Funding Partners!