Care coordination effective in chronic health cases.
Highmark Blue Shield's Caring Foundation launched the program in late 2004 in an effort to ensure that children with chronic illnesses and multiple diagnoses could access health care services. The program matches eligible children who are enrolled in the Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark Blue Shield with a community-based care coordinator.
For most families, the care coordinators offer education and referrals by telephone or e-mail. However, for families in need of a greater level of support, the care coordinators make home visits, accompany families to physician appointments, and even go to the child's school to educate the teachers about the child's condition. The care coordinators, most of whom are nurses, also design a personalized care plan, which lists the child's medications and physicians and can be easily shared among providers.
Officials at Highmark's Caring Foundation decided to develop the program after hearing from families that they had trouble focusing on finding the right health care provider because they were struggling with everyday essentials like housing, food, and heat, Caring Program director Mary Kay Holleran, R.N., said at a briefing sponsored by the Blue Cross and Blue Shield Association.
"Children with special health care needs very often have to navigate a very difficult maze of services," she said. "This sometimes inefficient and uncoordinated system has an enormous financial and emotional implication for the families."
Since its inception, more than 8,500 children and families have received services through the program and many are still with the program, Ms. Holleran said. Of those, about 500 received intensive services, including home visits by care coordinators.
In an analysis of the first year of the program, researchers at the University of Pittsburgh found that children who received intensive support from a care coordinator had fewer emergency department visits, fewer unplanned inpatient admissions, and lower costs for durable medical equipment. However, the researchers did notice an increase in prescription costs for these children.
The cost findings are encouraging, Ms. Holleran said. The rise in medication costs could signal that children are getting appropriate treatments that are helping them to stay out of the hospital.
Even with the increase in prescription costs, the researchers estimated that the care coordinator program saves an average of $334 per member per year.
The researchers also performed a psychosocial analysis of the families who enrolled in the program during the first year. They found decreased anxiety among the parents, decreased out-of-pocket expenses, decreased school absences, and fewer problems with grades.
One surprise that came out of the program was how unprepared schools are to care for children with chronic health conditions, Ms. Holleran said. They had expected to find that poor coordination among physicians would be the biggest problem, but instead found enormous gaps in knowledge at the school level.
In one case, the mother of a 5-year-old girl with type 1 diabetes was concerned about having her daughter start kindergarten because she didn't feel the school would be able to handle her daughter's medical needs. The school's initial plan was to call the mother out of work or call an ambulance if any problems developed. So the care coordinator worked with the state health department to bring a nurse educator into the school. They provided information to the teachers about how to manage the girl's diabetes without constantly calling her mother out of work, as well as when it would be appropriate to call an ambulance.
The Caring Program is continuing among children who are enrolled in CHIP through Highmark, and may be expanded to the commercially insured pediatric population in the future, Ms. Holleran said. It was one of four Blue Cross and Blue Shield company programs recognized by the Blue Cross and Blue Shield Association as an innovative approach to improving health and wellness. The other "BlueWorks" winners include programs that address racial and ethnic disparities in health care, and that encourage children to adopt healthy lifestyles.
The BlueWorks program is juried by the department of health care policy at Harvard Medical School, Boston, in consultation with physicians from the American Academy of Pediatrics, the American College of Physicians, and the American Cancer Society.
BY MARY ELLEN SCHNEIDER
New York Bureau
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||PRACTICE TRENDS|
|Author:||Schneider, Mary Ellen|
|Date:||Feb 1, 2009|
|Previous Article:||Developing leadership, Part 1.|
|Next Article:||UnitedHealth to replace database, settles lawsuit.|