High-risk children suffering from chronic diseases who received comprehensive care at a special clinic at The University of Texas Health Science Center at Houston (UTHealth) experienced dramatic reductions in both serious illnesses and hospital costs, according to a study recently published in JAMA.
The High Risk Children’s Clinic, a comprehensive care clinic or enhanced medical home, reduced the number of children with a serious illness by 55 percent and total hospital and clinic costs to $16,523 from $26,781 per child per year. Improvements were also noted for emergency department (ED) visits — a reduction of 48 or 69 percent — hospitalizations, number of days in the hospital, intensive care unit (ICU) admissions and days in the ICU. Parent satisfaction was also greatly enhanced. The clinic is part of UT Physicians, the clinical practice of UTHealth Medical School, and is staffed by physicians and nurse practitioners (NPs).
The researchers randomly assigned 201 high-risk children with chronic illness to receive comprehensive care, which included treatment from primary care clinicians and specialists in the High Risk Children’s Clinic, or usual care provided locally in private offices or faculty-supervised clinics. Patients were defined as high-risk with chronic illness if they had three or more ED visits, two or more hospitalizations, or one or more pediatric ICU admissions during the previous year, and a greater than 50 percent estimated risk for hospitalization.
Medical homes are potentially the most cost-effective for high-risk patients, particularly high-risk children with chronic illness whose care is often fragmented, costly and ineffective. Most children with chronic illnesses severe enough to quality for this comprehensive care program are enrolled in Medicaid. But reimbursement remains the greatest challenge. Current Medicaid reimbursements do not come close to covering the costs of this program even though it substantially reduces overall health system costs. Without adequate Medicaid reimbursements, institutions that have the expertise to provide such care programs will be unable to implement or sustain them.
Prior to this study, the patient-centered medical home’s value in improving clinical outcomes or reducing healthcare costs had not been demonstrated in clinical trials in children with chronic illnesses or in any group of adults. This study’s results were the greatest identified to date for medical homes for patients in any age group, researchers noted.
Source: University of Texas, December 23, 2014
Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination describes WellPoint’s efforts to define these roles and responsibilities: the testing of care compacts in its Patient-Centered Specialty Care (PCSC) program. In this 2014 venture, WellPoint recruited 20 progressive specialist practices to work with its established patient-centered medical home practices to test the use of care compacts as a means of bridging primary care-specialist collaborations.