Caring for Children With Special Healthcare Needs in the Managed Care Environment

Abstract

Dramatic medical and technological advances over the past 15 years have resulted in the survival into adulthood of children with chronic health conditions. As this population subset has increased, the demand of caring for these children in the managed care arena has become challenging from a clinical, fiscal, and member satisfaction perspective. A disease management program was designed for children, ages birth through age 18, identified as having special needs at the time of birth or at any point throughout childhood related to disease processes such as diabetes, sickle cell disease, genetic aberrations, or the multiple complications of extreme prematurity. Components of the program included identification of the population, coordinated risk assessment, and ongoing case management interventions. Most important, outcome indicators were tracked to demonstrate program effectiveness. The formulation and function of a dedicated disease management database is also discussed.

Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay for Children With Special Health Care Needs

“…Care in this medical home was also primary care–based with professionals in nutrition, gastroenterology, neurology, and allergy/immunology available once monthly. Similar hospital cost avoidance has been shown using primary care– or nurse practitioner–based models for CSHCN . To our knowledge, ours is the first study to suggest a decrease in hospital stay for patients with multiple aerodigestive comorbidities treated by a physician-led, multidisciplinary, specialty care model that emphasizes partnership with community-based primary care pediatricians.…”

Models of Care Delivery for Children With Medical Complexity

“…23 This standalone care-manager model has the advantage of the delegation of nonclinical, often time-intensive duties to staff who ideally have increased community insight, and connections are often less costly to the health care system than advanced medical providers. 20 A few evaluations of insurance caremanager programs have revealed cost savings and improved diseasespecific outcomes for children with chronic conditions 24,25 ; however, there remains little evaluative literature on this model overall or specifically for CMC.…”

Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

“…Similar to our findings, despite the largely positive findings reported, the authors found generally weak study designs, inconsistent outcome measures, and a lack of comparison groups in most studies. Although the medical home model is meant to be a primary care community-based model, there was some overlap in their article and ours owing to liberal inclusion criteria in both reviews; 6 studies 26,39,42,49,50,57 among the 30 were included in our review. Some studies in the review by Homer et al 61 were hospital based and included only parts of the medical home model, while some studies herein included a substantial community-based component.…”