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The missing piece: medical homes for California's children with medical complexity

Series Title(s):
Report (Lucile Packard Foundation for Children's Health)
Author(s):
Lobas, Jeffrey G., author
Contributor(s):
Lucile Packard Foundation for Children's Health, issuing body.
Publication:
Palo Alto, CA : Lucile Packard Foundation for Children's Health, September 2014
Language(s):
English
Format:
Text
Subject(s):
Child Health Services -- trends
Health Services Needs and Demand
Patient Care Management
Patient-Centered Care
Child
Chronic Disease
Forecasting
Vulnerable Populations
Humans
California
United States
Genre(s):
Technical Report
Abstract:
Description of Project. Children with Medical Complexity (CMC), a subgroup of children with chronic health problems, make up a small but especially vulnerable population in California. These children are characterized by their dependence on multiple pediatric subspecialists and often on medical technology; they are medically fragile and are particularly dependent on care coordination to maintain stable health. Although few in number they account for a disproportionate share of health care costs for children. This project set out to understand how CMC are currently receiving health care, what ideal health care for them might look like, and what the barriers to obtaining optimal care might be. Eleven primary care programs, most associated with children's hospitals, have established programs for this population, and these programs are the focus of this report. Chief medical officers and program directors from each facility were interviewed about the organization and operation of their clinics that care for CMC. Data were collected and a report was generated that became the focus of an in-person meeting and several telephone meetings among program leaders. The information collected and the dialogues that ensued were the source for this analysis. Findings. The study identified eight key focus areas as critical, high-leverage program components that must be addressed if existing services are to be improved and extended. These were Models of Care; System Design and Regionalization; State and Federal Policy; Workforce Development; Research; Data and Quality; Financial Models; and Mental Health. Summary. Each of the 11 centers is attempting to incorporate the principles of the Patient Centered Medical Home into their care of CMC, but their approaches and capabilities vary greatly. Some centers have adopted team-based care, electronic medical records, care coordination and outreach services, while others consist of a small number of dedicated physicians with little ancillary support. Some clinics serve as the medical home for CMC, while others also support local, community primary care providers who are assuming some ongoing responsibility for CMC. Because of their distribution within the state, these centers are regional in scope, though they are not formally organized in that way. Providers in the centers are uniformly committed to providing high quality care, yet they tend to be working with little institutional support, inadequate reimbursement, and in isolation from each other and from their colleagues caring for CMC in other states. Many more children could benefit from receiving coordinated, complex care but services are not available to meet the need. Conclusion and Recommendations. Specialized primary care clinics, operating as team-based medical homes, are a feasible and valuable component of a comprehensive system of care for children with complex care needs. They are likely to be cost-saving to the health care system overall, and undoubtedly provide higher quality care and greater patient/family satisfaction. However, the potential contribution of these clinics is not well appreciated by payers and sometimes not by the institutions with which they are affiliated. Children's medical centers, especially those desiring to be part of an organized delivery system for children with chronic health care problems, should be developing and supporting complex care clinics, and advocating for changes in health care reimbursement and financing that would help support the operation of these clinics. A collaborative, regional approach to team-based primary care for CMC would be a major achievement and a major contribution to the health and well-being of these highly vulnerable children.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Extent:
1 online resource (1 PDF file (16 pages))
Illustrations:
Illustrations
NLM Unique ID:
101666237 (See catalog record)
Series Title(s):
Report (Lucile Packard Foundation for Children's Health)
Author(s):
Lobas, Jeffrey G., author
Contributor(s):
Lucile Packard Foundation for Children's Health, issuing body.
Publication:
Palo Alto, CA : Lucile Packard Foundation for Children's Health, September 2014
Language(s):
English
Format:
Text
Subject(s):
Child Health Services -- trends
Health Services Needs and Demand
Patient Care Management
Patient-Centered Care
Child
Chronic Disease
Forecasting
Vulnerable Populations
Humans
California
United States
Genre(s):
Technical Report
Abstract:
Description of Project. Children with Medical Complexity (CMC), a subgroup of children with chronic health problems, make up a small but especially vulnerable population in California. These children are characterized by their dependence on multiple pediatric subspecialists and often on medical technology; they are medically fragile and are particularly dependent on care coordination to maintain stable health. Although few in number they account for a disproportionate share of health care costs for children. This project set out to understand how CMC are currently receiving health care, what ideal health care for them might look like, and what the barriers to obtaining optimal care might be. Eleven primary care programs, most associated with children's hospitals, have established programs for this population, and these programs are the focus of this report. Chief medical officers and program directors from each facility were interviewed about the organization and operation of their clinics that care for CMC. Data were collected and a report was generated that became the focus of an in-person meeting and several telephone meetings among program leaders. The information collected and the dialogues that ensued were the source for this analysis. Findings. The study identified eight key focus areas as critical, high-leverage program components that must be addressed if existing services are to be improved and extended. These were Models of Care; System Design and Regionalization; State and Federal Policy; Workforce Development; Research; Data and Quality; Financial Models; and Mental Health. Summary. Each of the 11 centers is attempting to incorporate the principles of the Patient Centered Medical Home into their care of CMC, but their approaches and capabilities vary greatly. Some centers have adopted team-based care, electronic medical records, care coordination and outreach services, while others consist of a small number of dedicated physicians with little ancillary support. Some clinics serve as the medical home for CMC, while others also support local, community primary care providers who are assuming some ongoing responsibility for CMC. Because of their distribution within the state, these centers are regional in scope, though they are not formally organized in that way. Providers in the centers are uniformly committed to providing high quality care, yet they tend to be working with little institutional support, inadequate reimbursement, and in isolation from each other and from their colleagues caring for CMC in other states. Many more children could benefit from receiving coordinated, complex care but services are not available to meet the need. Conclusion and Recommendations. Specialized primary care clinics, operating as team-based medical homes, are a feasible and valuable component of a comprehensive system of care for children with complex care needs. They are likely to be cost-saving to the health care system overall, and undoubtedly provide higher quality care and greater patient/family satisfaction. However, the potential contribution of these clinics is not well appreciated by payers and sometimes not by the institutions with which they are affiliated. Children's medical centers, especially those desiring to be part of an organized delivery system for children with chronic health care problems, should be developing and supporting complex care clinics, and advocating for changes in health care reimbursement and financing that would help support the operation of these clinics. A collaborative, regional approach to team-based primary care for CMC would be a major achievement and a major contribution to the health and well-being of these highly vulnerable children.
Copyright:
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
Extent:
1 online resource (1 PDF file (16 pages))
Illustrations:
Illustrations
NLM Unique ID:
101666237 (See catalog record)