Michigan Children’s Healthcare Access Program (MI-CHAP) Asthma Initiative of Michigan Partnership Forum 5/31/12 The Great Start Collaborative of Kent County is a major partner of First Steps
Pediatric Medical Home “A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective .” American Academy of Pediatrics The Great Start Collaborative of Kent County is a major partner of First Steps
History • Concept originated in 1967 by the American Academy of Pediatrics (AAP) • Initially designed for children with special health care needs • In last 10-15 years, has expanded to include ALL children • Patient-centered medical home (PCMH) movement arose from this original concept The Great Start Collaborative of Kent County is a major partner of First Steps
The Beginning: The Kent County Children’s Healthcare Access Program (CHAP) The Great Start Collaborative of Kent County is a major partner of First Steps
THE NEED • 41% of Michigan children are currently enrolled in Medicaid last year – up from 23% in 2001 • 35% of families with children on Medicaid report having difficulty finding providers who will accept their coverage • Michigan has one of the lowest Medicaid reimbursement rates in the country, approximately 50% of Medicare rates The Great Start Collaborative of Kent County is a major partner of First Steps
THE NEED • Children on Medicaid in Michigan and Kent County have poorer health outcomes than children with private insurance • Low Medicaid reimbursement makes it difficult for practices to accept large numbers of children with public insurance • Teaching clinics and FQHCs are overwhelmed by the numbers of Medicaid patients they are asked to see causing more limits to access • Costs due to poor preventive care for Medicaid children are significant in terms of ED use and hospitalization rates The Great Start Collaborative of Kent County is a major partner of First Steps
THE NEED • Michigan children with public or no health insurance have poorer health outcomes than privately insured children, including: • Significantly higher hospitalization rates • Higher rates of mortality when hospitalized • More severe illnesses resulting in hospitalization • Significantly higher rates of respiratory illnesses, including asthma • More visits to the emergency room • Higher readmission rates for newborns after discharge from the hospital The Great Start Collaborative of Kent County is a major partner of First Steps
THE NEED If the hospitalization rate for children on Medicaid was the same as for those with private insurance, the estimated savings for one year would be $300-$400 million. The Great Start Collaborative of Kent County is a major partner of First Steps
What is CHAP? Collaborative, community-based medical home improvement program that provides: • Technical assistance to improve “medical homeness” of primary care practices • Resource coordination of community services • Increased office, patient and family education • Needed services for children/families • Office efficiency assistance • Convening of community stakeholders to address systems issues The Great Start Collaborative of Kent County is a major partner of First Steps
DESIRED OUTCOMES Improve health outcomes among children on Medicaid while better utilizing existing resources and decreasing costs • Decrease inappropriate use of emergency departments and hospitalizations • Increase appropriate use of medical home. – Increase access to a medical home – Improve medical home quality – Provide supportive services and parent education • Advocate for system-level improvements in the delivery of health care to children The Great Start Collaborative of Kent County is a major partner of First Steps
CHAP Asthma Program Goals: • Identify and address systems barriers that prevent CHAP patients from optimally managing asthma • Increase access to and coordination of asthma services for children on Medicaid • Standardize asthma management in Kent County • Reduce emergency department use and hospitalizations related to asthma among target population The Great Start Collaborative of Kent County is a major partner of First Steps
HISTORY OF CHAP • Implemented by Kent County in 2008 • Primary Partners • First Steps • Helen DeVos Children’s Hospital • Priority Health • Great Start Collaborative of Kent County The Great Start Collaborative of Kent County is a major partner of First Steps
FUNDERS • W.K. Kellogg Foundation • Grand Rapids Community Foundation • Priority Health • Helen DeVos Children’s Hospital • Heart of West Michigan United Way • Steelcase Foundation • Frey Foundation • Early Childhood Investment Corporation • Spectrum Health’s Healthier Communities The Great Start Collaborative of Kent County is a major partner of First Steps
CHAP Works on Three Levels • Family • Provider • System The Great Start Collaborative of Kent County is a major partner of First Steps
PROGRAM COMPONENTS – Family Level Strategies • Parent education re: • Avoiding ER use • Importance of preventive visits and immunizations • Use of medical home • Referral to community resources • Home-based asthma case management • Care coordination and patient navigation • Same day transportation • Interpretation services The Great Start Collaborative of Kent County is a major partner of First Steps
Partnership with ANWM • Seamless collaboration between ANWM and CHAP • Asthma team: AE-Cs, MSWs, CHWs • Regular case management team meetings • Shared database and outcomes The Great Start Collaborative of Kent County is a major partner of First Steps
PROGRAM COMPONENTS – Provider Level Strategies • Technical assistance to improve practice efficiency and “medical homeness” • Provider education re: best practices • Networking opportunities • Nurturing new physician leaders in the community The Great Start Collaborative of Kent County is a major partner of First Steps
CHAP Practice Profiles Points Scored 1. Asthma in-service for staff 2. Asthma ed. For patients 3. In-office asthma educator 4. Referral to CHAP/ANWM 5. Teach peak flow monitoring 6. ETS assessment 7. In-office spirometry 8. AAP 9. ACT 10. Asthma registry 11. Routine 6-month asthma visits 12. Document flu shots
PROGRAM COMPONENTS – System Level Strategies • Increase access to primary care by partnering with MDCH and Medicaid health plans to enhance reimbursement, provide incentives, and increase Medicaid openings in primary care practices • Improve communication between different health care systems to improve patient care • Catalyst for change and convener of stakeholders when problems are identified in the community The Great Start Collaborative of Kent County is a major partner of First Steps
PROGRAM COMPONENTS – System Level Strategies Development of new programs/initiatives/workgroups: • Asthma • Dental Access • Childhood Obesity • Mental Health Access • Developmental Screening The Great Start Collaborative of Kent County is a major partner of First Steps
DEMONSTRATION PROJECT DETAILS: Target Population: ~15,000 children ages 0-17 receiving Priority Health Medicaid in Kent County Timeframe: August – December 2008: Ramp up 2009 – 2011: 3 Year Demonstration Project 2012: Expansion and Replication Pilot Sites: • Private Pediatric Practices • Federally Qualified Health Center - 9 community and school-based clinics • Pediatric Resident Clinic • Nurse Practitioner Clinic • Total Providers: 40 pediatricians and 10-12 FP’s and midlevel providers The Great Start Collaborative of Kent County is a major partner of First Steps
Partnership with Priority Health • Priority Health initiated the partnership during CHAP planning stage • Participated in the design of the project • Ongoing involvement at all levels of project • Participation on ongoing leadership team and CHAP Advisory Committee The Great Start Collaborative of Kent County is a major partner of First Steps
2010 Practice-level Outcomes Change ↓ 13.8% from baseline period to 2010 Including: Change ↓ 12.3% from baseline period to 2010 Excluding: Change ↓ 6% from baseline period to 2010 The Great Start Collaborative of Kent County is a major partner of First Steps
2010 CHAP Client Outcomes (n= 2197) Change ↓ 35% from 12 months before to 12 months after 1 st referral date *Clients served defined as clients that were touched by at least one CHAP service Change ↓ 62% from 12 months before to 12 months after 1 st referral date *Clients served defined as clients that were touched by at least one CHAP service The Great Start Collaborative of Kent County is a major partner of First Steps
2010 COST-BENEFIT ANALYSIS • The immediate social benefits of CHAP exceeded the costs by 20% -- a return of $1.20 of every $1.00 invested • Priority Health recouped its investment in 2009 and 2010 – CHAP was cost-neutral for the health plan The Great Start Collaborative of Kent County is a major partner of First Steps
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