• Article
  • October 4, 2017

Proactive Care Management Promotes Quality Outcomes for Patients with Medical Complexity

This is the sixth 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, Cincinnati Children's Hospital Medical Center.

For Lisa Crosby, the timing of Cincinnati Children's Hospital Medical Center's inclusion in the CARE Award program was fortuitous. "We were fortunate our care management model rolled out almost simultaneously with the CARE Award," says Crosby, DNP, APRN, PMHS, the APRN Clinical Manager for Cincinnati Children's Division of General and Community Pediatrics. "We had the organizational structure and support, as well as technology support, which helped us launch."

Leadership is key

Cincinnati Children's launched its care management program to focus extensive care coordination on its highest-risk patient population. Care managers focus on mitigating risks in order to improve patient outcomes; including closing any potential gaps in care.

The success of the program depends on, among other things, a strong organizational structure, administrative support and having the proper technology in place. Perhaps most critical, Crosby says, is a strong team with defined roles, where the care manager is the clear team leader.

"The coordination of care is the responsibility of all team members, but someone has to own it," says Crosby. "You can't have six bus drivers because the bus isn't going to go in six different directions. Everyone on that bus is important, but someone has to drive."

Learning from peers

With more than 30,000 active patients across its four care centers—nearly 1,100 of whom have participated in the CARE program—Cincinnati Children's naturally faces its share of challenges and barriers to success. One of the keys to overcoming those challenges has been its peer-to-peer learning program.

"It has had a significant impact on our front line care managers," says Crosby. "It has allowed our teams to look more intricately at their practice as care managers, which has been insightful."

The team at Cincinnati Children's developed a peer-to-peer review tool to provide care managers a critical appraisal of their practice from their contemporaries at the hospital. The process focuses primarily on the clinical process: patient assessment, stratification, planning and intervention, and ongoing proactive management. The review process identifies the strengths of the practice as well as opportunities for growth, and offers strategy on overcoming any obstacles.

Becoming proactive

One of the primary objectives of the peer-to-peer learning process has been to elevate the hospital's care management practices, and the team at Cincinnati Children's is pleased with the results.

"It has given us the ability to be proactive," says Crosby. "That has been important around care management. It's not just coordinating the care, but how we've become proactive to help our patients and families prevent unnecessary utilizations—and more importantly, to promote health."

The CARE study findings, anticipated by year-end, will serve as a key resource for team members at Cincinnati Children's 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 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# 3216, Approved 9/29/2017