Cost Reduction

CHECK Targets Chronic Care Costs For Children

November 10, 2016 9:49 am

Community health workers are hired and trained to implement healthcare interventions.

“Families and children on Medicaid with chronic conditions often need help with disease self-management. They need a support system to navigate the healthcare system and help with the social determinants of health, such as education, transportation, and housing,” says Molly Siegel, executive director of a program called Coordination of Healthcare for Complex Kids, better known as CHECK, at the University of Illinois at Chicago.

“Our aims at CHECK are to reduce healthcare costs, increase patient engagement, and reduce school absenteeism,” Siegel says. “There is a strong connection between improving overall health, reducing social stressors, and decreasing school absenteeism.”

How did CHECK get started?

CHECK was created in response to a request for proposals for the CMS [Centers for Medicare & Medicaid Services] Healthcare Innovation Awards. There was no program like CHECK, so several folks at the University of Illinois Chicago came together to write the grant. We received a $19 million award, one of the largest in the second round of innovation grants. It’s a three-year grant, and it ends in September 2017.

We committed to engage 6,000 families, and we have already engaged approximately 5,200, so we’re in a really good place to hit the target by the end of the program.

How does CHECK help children on Medicaid with chronic conditions?

The kids in CHECK are assigned community health workers who help the children and their families deal with the chronic illnesses. Community health workers are community residents who are hired and trained by healthcare providers to implement health interventions in their communities. For example, in the case of a child with asthma, the community health worker introduces equipment and supplies that help children cope with asthma. One example is a “spacer,” which connects to an inhaler to make it easier to use. Community health workers also provide motivational interviews with patients to determine their goals and hopes, and then they create a care plan. They also use technology as an aid, such as texting reminders to the family.

When it’s needed, CHECK can partner with asthma specialists, such as pulmonologists, so patients can get appointments with them. These specialists devote a percentage of their time to CHECK, and they are paid for that time.

We take a holistic approach and work with the entire family. We enroll other children in the family who are in need of CHECK’s services, and we provide social support services such as transportation, housing services, child care, mobile dental care, and legal support to parents, including mental health services if needed.

We have a long-term view of prevention. Even though we work with the high-risk kids and can show we’ve saved money with that population, we also work with kids who are low- and medium risk, too, because we want to prevent them from going into the high-risk category. CHECK takes a dual approach focusing on the immediate needs of the family but also reducing stressors and coordinating social services for a longer-term preventive impact. What makes CHECK innovative is the combination of resources, support services, and staffing models all operating together within the same setting.

Who are the people behind CHECK?

The 30 community health workers who work for CHECK are the cornerstone of the program’s disease management care coordination. Community health workers are community residents hired and trained by healthcare providers to assist patients and families in identifying barriers to health care, utilizing community resources, and implementing health interventions in their communities. The community health workers meet families in their homes, at clinic appointments, and during hospitalizations. A team of care coordinators and nurses supports the teams of community health workers. CHECK also has a strong data team to continuously review and make improvements to the program, engaging in rapid cycle improvement.

In addition, we have a mental health promotion team. We know behavioral health is a big challenge in the healthcare system, and it can affect the entire family. It can also be a reason for inappropriate utilization of hospitals, so it’s definitely something we address head on.

Some of our other staff are data and technology workers. The CMS grant will last for three years, so we need to have the data to show that CHECK will be sustainable after that period, though with a different funding source.

What partnerships have helped with this program?

We partner with a mobile dental care van called Mobile Care. We know the dental needs are huge for this population, so we offer dental events where kids can come and get cleanings and preventive services. We try to make it fun for them.

We also have a medical legal partnership. Our lawyer helps patients get their Social Security benefits, makes sure their housing rights are in order, and helps with legal issues related to schools.

We’ve also partnered with 50 community medical organizations and primary care providers. We are creating a map that shows where these organizations are located, so CHECK participants can find these resources and feel comfortable going to them.

What financial results have you seen from the program?

We don’t have definitive data yet, but we have seen a decrease in utilization for the highest-risk populations. We have two years of claims data from Medicaid here in Illinois, which we’re using as a baseline. In the next couple of months, we’ll get the latest data, which will show more precisely how these children have done while being enrolled in CHECK.

Once we have that data, we’ll go to potential payers, such as a health plan, and say, “Here are the results of our program. We would like to talk with you about entering into a financial partnership—a collaboration around mutually caring for these families.”

What’s the future of CHECK?

This program represents the future of healthcare from our perspective. It just makes sense to have population health community-oriented programs that are based in clinical settings, or partner with clinical settings, and partner with health plans. It’s similar to the ACO [accountable care organization] model, but we’re bringing in more of a community focus.

Ed Avis is a freelance writer and editor and a regular contributor to HFMA publications.

Interviewed for this article:

Molly Siegel is executive director, Coordination of Healthcare for Complex Kids.


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