A care pathway is meant to connect a child with the specialized care they need.
For military families, that journey spans multiple health systems. Referrals move through military and civilian providers, medical records transfer between organizations, and families must establish relationships with a new network of subspecialists.
When communication breaks down, access to care slows.
Leaders at Norton Children’s and Fort Knox’s Ireland Army Health Clinic saw an opportunity to improve their process. Over the past 18 months, the organizations have worked together to strengthen how military families access pediatric specialty care.
The effort was designed so families would not have to navigate gaps between two health care systems on their own.
“We worked to build a connected infrastructure between the military and civilian health care systems, so families did not have to serve as the bridge between the two,” said Heather Rich, director of regional pediatric provider relations and development at Norton Children’s.
Together, these efforts have impacted hundreds of military children and their families through improved coordination and stronger relationships between military providers and pediatric subspecialists.
Initial challenges
Children often arrive in Kentucky having already established care with multiple pediatric subspecialists and care teams elsewhere. Families then have to reestablish care near Fort Knox while simultaneously adjusting to a new community.
Norton Children’s met with command leadership from Ireland Army Health Clinic and Humana Military TRICARE Health Systems and identified several recurring friction points. Communication between military providers and pediatric subspecialists was often indirect, and providers had limited opportunities to build relationships across the systems.
“We had to understand how both systems operated and where the barriers existed to identify opportunities to make access easier for providers and families,” Rich said.
Earlier involvement
One of the first process changes involved enhancing coordination with the military’s Exceptional Family Member Program (EFMP).
The health system developed relationships with EFMP nurse navigators and coordinators at Fort Knox. Rich looped in coordinators earlier in the process to help remove barriers for active-duty service members.
“When a child needs specialized care that isn’t available at the next duty station, it can affect a family’s ability to relocate,” Rich said. “That makes access to care important not only for the family, but also for our nation’s military readiness.”
Through this enhanced EFMP coordination, 22 children with complex care needs and their families have received assistance navigating access to pediatric specialty care.
Today, EFMP coordinators alert Norton Children's when they encounter access issues for a military family with a child who has complex care needs and is relocating to Fort Knox. The early notification allows teams to begin identifying specialty care resources, reviewing available records, and removing any access barriers.
Streamlining access
The partnership also identified operational challenges within the referral process.
Military families often navigate multiple health care systems and administrative processes when establishing specialty care. Referrals move through Humana Military TRICARE insurance review before reaching the health system. Leaders discovered referral information sometimes remained within the military referral portal before being transferred into Norton Children’s electronic health record.
Norton Children’s responded by updating internal workflows to make the process more seamless.
The health system collaborated with its pediatric access center and Humana Military to strengthen coordination and help military families more easily navigate specialty care access.
Norton Children's created a dedicated phone structure option to connect military families with schedulers familiar with the TRICARE referral process. The schedulers now have access to the TRICARE portal, allowing them to retrieve patient information, review documentation and medical records, and help move appointments forward more quickly.
“We knew we needed a dedicated process that improved longitudinal communication,” Rich said. “Our Norton Access Center leaders focused on structuring the communication pathway, from first call to scheduling, so it would be more user-friendly for military families.”
Stronger relationships
Norton Children’s also wanted to build relationships between military providers and pediatric subspecialists to strengthen communication and clinical collaboration.
Rich initiated quarterly pediatric provider education with providers at Ireland Army Health Clinic. Norton Children's began bringing pediatric subspecialists to Fort Knox for sessions with military physicians, nurse case managers, and staff.
The relationships have also made it easier for military physicians to connect with the hospital experts for consultation, care coordination, and clinical guidance. Providers know who to call, how to reach them, and when a situation may need faster intervention.
“We wanted military providers to know our specialists and feel comfortable reaching out when they needed additional support,” Rich said. “Building those relationships helps improve continuity of care that better serves military children and their families.”
Designing around families
The improvements Norton Children’s and Ireland Army Health Clinic implemented came from examining the care journey through the eyes of military families.
The approach shifted more of the coordination burden from families to the organizations serving them. Through earlier EFMP coordination, dedicated access resources, and stronger provider connections, military families have clearer pathways to the specialty care their children need.
For Rich, the work underscores a broader responsibility for children’s hospitals serving military communities.
“Our two organizations were doing important work, but much of it was happening in siloes,” Rich said. “We saw a great opportunity to strengthen that partnership, better understand the military health care landscape, and support both the families we serve and the military’s mission.”
