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Project Name: Enhancing Systems of Care for Children with Medical Complexity (UM2)
Applicant Title: University of Texas At Austin
Abstract Text: • Project Director: Lisa Kirsch • Address: 1601 Trinity St., Bldg. A, Austin, TX 78712 • Ph: xxx-xxx-xxxx • Email: xxxxxxxxxxx@xxxxxx.xxxxxx • Website: https://dellmed.utexas.edu/ • Funding Request: $400,000/year Through this demonstration, Dell Medical School at the University of Texas at Austin (DMS) and Children’s Comprehensive Care clinic (CCC) will advance integrated care for children with medical complexity (CMC) by: 1) supporting expansion and continuous quality improvement (CQI) of CCC’s innovative care model, 2) piloting an alternative payment model (APM) to help sustain the model, and 3) evaluating and disseminating findings to inform policy on integrating care for CMC and their families to promote health equity and optimize health and quality of life in a cost-effective manner. CCC is a primary care clinic in Austin dedicated to the care of CMC, a population that needs significant medical, behavioral, and social services. Most of its 800+ patients are enrolled in Medicaid, and many have low incomes and/or do not speak English. Since 2018, CCC has improved health outcomes with support from a HRSA Collaborative Improvement and Innovation Network (CoIIN). Through the CoIIN, CCC built trusting relationships with dedicated partners, including Title V and Medicaid at Texas Health and Human Services (HHS), Blue Cross and Blue Shield of Texas (BCBS), Texas Parent to Parent, families, DMS, and other providers. CCC has redesigned care for CMC by assigning primary nurses for longitudinal, relationship-based care; using a shared data platform to develop care plans; delegating service coordination from BCBS to the health home; and engaging parent leaders in CQI. However, there continue to be many barriers to optimal care for CMC. The system is still too fragmented and onerous to navigate for families and providers, with administrative activities taking away from valuable time with children. Payment mechanisms do not incentivize integrated care. Technology is not optimized to effectively support care needs. All families of CMC experience these barriers, but additional health inequities exist based on income, race/ethnicity, and language. To optimize service delivery for CMC, along with improvements at CCC, there must be changes in process and outcome measures, regulatory oversight, and payment structure. Since 2016, children with disabilities in Texas Medicaid have been enrolled in a managed care model called STAR Kids, which increased administrative burdens for families and providers. In 2021, HHS solicited alternative care model ideas to improve care for CMC. With partners, CCC proposed a network of provider-led, integrated health homes for CMC with teams of health care professionals as described in the ACE Kids Act. Consistent with this concept, this project will further transform care by: • Expanding a pilot to help integrate care – biannual Whole Child Visits using telehealth to bring together the primary care team, specialists, and other providers to develop a comprehensive care plan with the child’s family. The goal of these visits is to improve health and well-being by identifying what matters most to the family, fostering shared decision making, and streamlining care planning. • Negotiating an APM with BCBS for these integrated visits. • Optimizing innovative technologies and empowering parents to be equal partners in their child’s care. • Engaging families from underserved communities in CCC’s Family Workgroup and conducting a health equity assessment with a corresponding action plan. • Making a five-year investment in evaluation of CCC’s novel care model to provide data to the Texas Legislature and HHS on the model’s impact on health outcomes, family well-being, health equity, utilization, and cost-effectiveness of care. Our goal is to inform policy and delivery system change to improve how care for CMC in Medicaid is organized and compensated in Texas and nationally.