How 10 Hospitals Redefined Care for Medically Complex Children

How 10 Hospitals Redefined Care for Medically Complex Children

Using new change concepts to improve care, avoid unnecessary visits and reduce spend, 10 hospitals transformed how they deliver care for children with medical complexity.

With health care costs topping $380 million each year, children with medical complexity are an important focus for children's hospitals. But, evidence-based practices that can be applied across all hospitals to improve care for these patients have been elusive. That inspired 10 children's hospitals to find a new approach to transform care delivery.

Before starting the project, hospital teams needed to consider how this effort would be different. "We use the term 'transformation' liberally right now around improvement in our culture," says Jane Taylor, MBA, M.H.A., Ed.D., quality improvement advisor and project faculty.

The project teams changed their thinking and tactics. For three years, they tested new change concepts to improve care, avoid unnecessary visits and reduce health care spending. Their results show it's possible do this transformative work well, without negatively affecting families.

The teams shared their experiences in a four-part webinar series. Learn how your hospital can adapt these strategies to:

  • Prioritize family partnerships. Most hospitals thought they were already using these families effectively in improvement efforts. They soon realized change could only happen when they engaged these frequent hospital users early in the design process and became full partners.
  • Design better practices. The teams designed care management tools to improve delivery of complex care. They focused on working with primary care physicians, implementing supportive technology, standardizing processes and removing silos that hampered communication between providers.
  • Expand care coordination. Because these children require care from multiple specialists, care coordination is critical for families and providers. The hospitals implemented care plans, access plans and contingency plans that prevented ED visits and hospitalizations.
  • Stabilize costs of care: Teams focused on developing alternative payment models as a better way to pay for these complex patients. They had to understand unusual local factors affecting cost of care and leverage what they already had. 

In addition to 10 children's hospitals, the Coordinating All Resources Effectively (CARE) Award included 8,000-plus complex Medicaid patients, 42 primary care sites and 10 payers.

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