• Article
  • July 27, 2017

Reducing Admissions, ED Visits and Length of Stay for Children with Medical Complexity

This is the fifth installment in a series on the CARE Award: "Coordinating All Resources Effectively." CARE is the basis of a national hallmark study aimed at improving quality outcomes and reducing costs of care for children with complex medical conditions enrolled in Medicaid. Children's Hospital Association partners with 10 of the nation's leading children’s hospitals on the CARE program, which encompasses more than 8,000 patients, as well as their caregivers and health care payers.

Here, we check in with one of CARE's participating institutions, Children’s Hospital of Philadelphia.

The numbers are eye-opening, and they speak directly to the need for focused complex medical care at Children's Hospital of Philadelphia (CHOP). According to David Rubin, M.D., M.S.C.E, founding co-director of PolicyLab and medical director of Population Health at CHOP, the top 1 percent of children the hospital sees each year account for a large share of the hospital's annual payments.

"We used the CARE Award to strengthen the connection between our hospital and our ambulatory network to better care for these medically complex children," Rubin says. "The CARE award allowed us to strengthen our primary care medical homes for care coordination; provide a new care coordinator role for hospital to home transition; and also develop our hospital-based care management program, Compass Care, for those who were too often in our ICUs and our hospital to be managed exclusively in primary care."

It was for this group of children, who often see many specialists and have multiple chronic conditions with technology dependence, that CHOP established Compass Care in 2014. The primary goals of Compass Care are to improve care coordination and overall quality of care, while delivering a better care experience for patients and their families who require a high volume of services at the hospital and its subspecialty practices.

Achieving goals

Through analyzing utilization metrics, the Compass Care team has seen dramatic improvement since it began enrollment in the CARE program:

  • The total number of days patients have spent in the hospital are down from 4.76 days per patient per month in the year prior to CARE enrollment to 1.26 days since enrollment.
  • There has been a reduction in ED visits per month for 47 percent of patients.
  • They've seen a reduction in hospital admissions for 61 percent of patients.
  • For those patients who were admitted to the hospital, 76 percent have experienced a reduction in average length of stay. 

The Compass Care program has had a measurable effect on patients and their families. Scores in family satisfaction surveys show consistent improvement with each subsequent interaction with the Compass Care team.
"We're proud of the impact we've been able to have on the patient and family experience," says Annique Hogan, M.D., Compass Care medical director. "Especially because we know that these are patients and families who spend a tremendous amount of time in our institution." 

Words of advice

Rubin shares some advice for other institutions looking to improve, or even begin, their own program for caring for patients with complex medical conditions:

  • Don't go too fast. Resist the temptation to implement too much, too soon. Be careful to not plan too far ahead of the capabilities of your grassroots teams—those doing the work on the ground.
  • Ensure institutional alignment. As budgets tighten, it's essential to have support across your institution to champion your cause.
  • Realize the opportunities. Even if you begin on a smaller scale—of CHOP's 775 CARE enrollees, less than 100 are enrolled in Compass Care—you can make a big impact. "We started small and demonstrated a tremendous return," Rubin says. "We've really opened people's eyes about the possibilities here."

The CARE study findings will serve as a key resource for team members at CHOP as they continue to evolve the system of care for children and families.  

About CARE

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. 

Send questions or comments to magazine@childrenshospitals.org.

Read other CARE hospital case studies.

This publication was made possible by Grant Number 1C1CMS331335 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. Pub: 3176, Approved 7/26/2017