Wednesday, January 26, 2011

Pediatric Medical Home Results

In an effort to do a better job of coordinating the care of children with cancer, heart disease, spina bifida, and other musculoskeletal abnormalities, craniofacial abnormalities, and severe gastrointestinal disorders, Mattel Children’s Hospital established the Pediatric Medical Home Program at UCLA. This program has resulted in fewer emergency department and fewer hospital visits with more outpatient urgent care being used. This is the first study to look at the benefits of the medical home concept in a specialized children’s hospital.

The children enrolled in the program receive virtually all of their medical care at UCLA including primary care and specialist visits. The program focuses on children with complex medical needs because these children have multiple diagnoses, go to sub-specialists, take many medications and use a variety of medical equipment. As a result, their care can be difficult to coordinate. At present, the program serves 110 patients and their families but the goal is to enroll 400 to 500 clinic patients who could benefit from this type of program within the next few years.

Initial funding sources for the program came from the American Academy of Pediatrics’ CATCH grant of $6,000 to help plan the program, a $50,000 a year “Healthy Tomorrows” grant from HRSA covered operating costs during the pilot study, along with an additional $100,000 a year in funding from the Skirball Foundation to enable the program to expand.

Today, the program’s budget comes from the UCLA Department of Pediatrics, but also from a large group of local foundations, and from Medi-Cal. It is thought that changes included in the present health reform legislation combined with potential changes in state-level reimbursement may provide for increased reimbursement for program services.

To begin developing the program, Thomas S. Klitzner, M.D. PhD, Professor of Pediatrics at the hospital worked with a small group of individuals on securing grants and then created a larger committee to develop the program. After securing funding from HRSA, the initial pilot study was undertaken enrolling 43 patients in 2003-2004. At this point, residents were trained and a part time pediatrician was hired.

The UCLA pediatric residents are directly involved with making the program work. All of the patients are assigned a primary pediatric resident for their primary care. As the pediatric residents see more chronically ill patients, and participate in their care coordination, they become comfortable and experienced in taking care of pediatric patients with complicated medical problems.

The question at this point is how to sustain the program and how to establish relationships with would-be-funders. Until payment systems adequately reimburse for services provided by medical home programs is available, outside funding is essential to support program operations. UCLA program now has relationships with roughly 30 foundations to help keep the program operational for the next several years.

Currently, the founders of the program are approaching the public and private insurers along with community-based organizations to educate them on the benefits of the program including the potential to reduce emergency department visits.

The concept to serve other populations is under consideration. The program was originally implemented for a medically complex, socioeconomically disadvantaged patient population. However, the program could possibly be applied to other challenging populations such as treating working age adults and seniors with multiple chronic conditions and especially those individuals facing socioeconomic or ethnic/racial barriers when trying to access care.