• Article
  • April 19, 2017

Streamlining Care for Patients with Complex Medical Conditions

This program improves outcomes and reduces costs for patients with complex medical conditions.

The Beacon Program at Children's Mercy Kansas City provides a primary care home for medically complex children and simplifies the process of managing care for their families. "Having a program that is comprehensive with everything we need in one place is something our families really appreciate," says Beacon Program Director Ingrid Larson, M.B.A., M.S.N., DNP, NEA-BC, APRN.

The Beacon Program is one of the participants in the CARE Award, a national hallmark study aimed at improving quality outcomes and reducing costs of care for children with complex medical conditions. In partnership with 10 of the nation's leading children's hospitals, the Children's Hospital Association received a three-year, $23 million Health Care Innovation Award from the Center for Medicare and Medicaid Innovation.

Of the roughly 3 million medically complex children nationwide, two-thirds are covered by Medicaid. These 2 million children represent nearly 40 percent of costs. They are clinically fragile and have intense medical and care coordination needs that are not always met by existing care delivery and payment models. To date, the CARE program encompasses more than 8,000 patients, as well as their caregivers and health care payers.

Larson, along with Chad Moore, J.D., M.H.A., Children’s Mercy's senior director of payer relations, shared their experiences.

A high-touch program

Communication around a patient's care occurs at all stages and levels and is a cornerstone to Beacon's success. The health care team at Children's Mercy has weekly team meetings to discuss current and incoming patients. The team conducts ad hoc interviews with parents and families and routinely surveys them following clinic visits regarding their care and clinic processes.

Families meet with their care team for a two-hour annual clinic appointment, to discuss all aspects of their child's care, and all parties sign a care agreement. The purpose: to ensure caregivers are carrying out the patient's health care plan effectively and to set clear expectations for clinicians and families.

Streamlining the coordination of care

A focus of the Beacon Program is to help families simplify the complicated care process for their children. Beacon achieves this by providing patients and families with enhanced access: 24/7 contact with clinicians, same-day ill appointment availability, options for telemedicine where available and in-person home visits.

Additionally, Beacon offers services designed to streamline the logistics of care coordination, including a centralized scheduling contact for all clinicians, consolidated appointments, and the opportunity to provide primary care for siblings at Beacon—a benefit that about half the families in the program use, Larson says.

Helpful advice

Larson shared how Beacon is tracking against the benchmarks measured in the CARE study, which is simultaneously transforming the care delivery and payment models for children with complex conditions. With experience gleaned from more than 1,000 of Children's Mercy's patients enrolled in CARE, including those in the Beacon Program, Larson offers some advice to other institutions looking to improve or begin their own complex care program:

  • Identify your role. Make the decision early on to determine if your program will take on a primary care or a specialty care role.
  • Set clear boundaries. This will help you manage incoming referrals. "When we started our program, we got flooded with the number of referrals," Larson says. "Now, our referral criteria is a little bit stricter, and we are just seeing the kids for whom we can make the biggest difference."
  • Partner with administration. This is critical to ensure proper staffing.
  • Build employee wellness into the program. This will help to prevent staff burnout, which Larson says is the number one issue all complex care programs face.
  • Provide clear guidelines. Larson considers the establishment of precise written guidelines at Children's Mercy—from new employee orientation to processes to definition of roles—as "one of our success stories."

The CARE study findings, which will be available at year end and into 2018, will serve as an important resource for the Beacon Program as it continues to evolve the system of care for children and families.

Send questions or comments to magazine@childrenshospitals.org.
Read other CARE hospital case studies.
This publication was made possible by Award Number 1C1CMS331335-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.