• Article
  • October 4, 2017

Hub Model: A Different Approach to Caring for Children with Medical Complexity

This is the eighth 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 medical complexity 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, Stanford Children's Health in Palo Alto, California, who will also present their work at the Annual Leadership Conference Nov. 7 in New Orleans.

The primary goal of the CORE (Coordinating and Optimizing Resources Effectively) Program at Stanford Children's Health is to provide improved care coordination and communication for children with medical complexity. While the program's name varies only slightly from that of the CARE Award, CARE was central to CORE's expansion.

Hub model

Stanford Children's Health employs a "hub model" rather than striving solely to provide a medical home for medically complex patients, it positions the CORE team, along with patients and their families, in the middle of the complex care universe. There, the CORE team manages care coordination and facilitates communication between the patient's family and their multiple caregivers, and among the caregivers themselves. 

The genesis of the CORE program's hub model came from feedback that Stanford Children's Health received from patient families who were clamoring for assistance in managing multiple care providers and navigating the complexities of the health care system.

"We encourage parents to share coordination concerns and challenges and to join us as partners in improving care for their children," says Karen Wayman, Ph.D., director of family-centered care at Lucile Packard Children's Hospital Stanford. "The key to CORE's success is the coordination of services between and among hospital staff, subspecialists and community providers."

Impressive gains

The CORE Program has thrived under the CARE Award. Fewer than 100 patients were enrolled in CORE in the first two years of its existence, but that number increased to 347 patients in the first full year of the CARE Award, with more than 700 patients now enrolled in CORE.

"When we first started CORE, we were focused on children admitted to the hospital," says Wayman. "As part of the CARE Award, we reached out to community-based pediatric practices to work in partnership to coordinate care for their most complex patients.

While CARE Award metrics are in process and pending, Stanford Children's Health internally tracked improvements in other key metrics prior to enrollment in the CARE program to the year after enrollment. Preliminary data for the most complex group of CORE participants indicates the

  • Number of patients with a hospital admission decreased by 49 percent
  • Total inpatient admissions decreased by 54 percent
  • Average ICU days per patient declined by 63 percent
  • ED visits decreased by 27 percent 

Additional analyses are now being conducted to validate these findings.

New prototypes

The CORE Program continues to evolve and is currently implementing three new additions to the program:

  • Care coordination liaison. This new role assists case managers and nurses with scheduling, helps with patient transportation and works with community health care providers to coordinate care.
  • ED flag project. This quickly delivers critical patient information to ED caregivers regarding the patient's medical history and contact information via the electronic medical record (EMR), saving precious time in the event of an emergency.
  • Monitoring system. This provides proactive patient contact on a periodic basis to ensure the families' needs are being met. The CORE team found the majority of patient families contacted under this program had critical coordination needs they weren't voicing to the care team.

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 children with medical complexities 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.

Read other CARE hospital case studies.

Send questions or comments to magazine@childrenshospitals.org.

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# 3218, Approved 9/29/2017