08/27/2008

First Steps Announces First Initiative: Children's Healthcare Access Program

The number of Kent County children who rely on Medicaid for their medical coverage increases every year; it's now approximately one in three. As that number grows, it becomes more and more difficult for low-income families to access primary healthcare. The Children's Healthcare Access Program, the first initiative of First Steps, is designed to help children get the care and support they need to stay healthy.

The Children's Healthcare Access Program is a community collaboration involving Priority Health, Helen DeVos Children's Hospital, four medical clinics, four private pediatric practices and human service agencies. Between 14,000 and 15,000 Kent County children, ages 0-17, who are enrolled in Medicaid are part of a one-year pilot project that started August 1. There are two primary goals: to improve the health of our community's children and reduce the cost of providing healthcare by avoiding expensive emergency room visits and hospitalizations.

"The vision of First Steps is that every child in Kent County will be ready to succeed in school and in life," First Steps co-chair Kate Pew Wolters said. "To make that vision a reality, our children have to be healthy. It is in our community's best interest that all children have quality healthcare."

The Children's Healthcare Access Program has a comprehensive approach to improving access:

    * Create more openings in private practices for children with Medicaid
    * Work with partners to offer more evening hours and same-day appointments
    * Provide home-based support services for families

Children's Healthcare Access Program image 1"All children deserve access to primary medical care," said Tom Peterson, medical director of the Children's Healthcare Access Program and medical director of quality at Helen DeVos Children's Hospital. "This program will increase access to multiple resources and reduce reliance on the emergency department for primary medical care. In turn, our community will see a better utilization of resources and healthier children. Innovative programs such as these have worked in other states. This is an opportunity to see those same positive results in Michigan."

A guiding principle of The Children's Healthcare Access Program is that all children should have a consistent medical home-a doctor's office or clinic-where they can always go for regular checkups, immunizations and treatment when they are sick. However, thousands of children in Kent County-especially children with Medicaid-do not have access to a medical home and, consequently, turn to the emergency room for their primary care.

First Steps conducted a study looking at the health of children with Medicaid compared to the health of children with private insurance. Both in Kent County and in Michigan, children with Medicaid have poorer health outcomes:

• Significantly higher hospitalization rate
• More severe illnesses resulting in hospitalization
• Significantly higher rate of respiratory illnesses, such as asthm
• More visits to the emergency room
• Higher readmission rates for newborns after discharge from the hospital

Those disparities are costly. We estimate the cost savings statewide would be between $150 and $200 million a year if publicly insured children in Michigan had the same hospitalization rate as privately insured children.

In response to those statistics, Priority Health, one of the largest Medicaid managed care providers in Kent County, is increasing the Medicaid reimbursement for sick child office visits at the eligible sites in the pilot project. In exchange the physicians are agreeing to accept additional Medicaid patients, opening access to approximately 1,000 children in need of a medical home. Priority Health is contributing up to $500,000 to the project but believes much of that money will be recouped by savings in emergency room and hospitalization costs.

"Our investment in this program is a direct reflection of our mission to improve health by providing access to affordable and excellent health care," said Kim Horn, president and CEO of Priority Health. "It is a first step in making meaningful changes in health care that have the power to improve the health of everyone in Michigan."

Families will receive support services that include home visits from a nurse case manager and an asthma case manager, linkage to community resources, mental health services and free same-day transportation. Partner clinics are investing their resources to significantly increase patient access by expanding their hours and offering more same-day appointments, so that children won't have to wait to see their primary care physician when they are sick.

All of the children who are part of the pilot project receive Priority Health Medicaid and are clients at one of the participating providers: ABC Pediatrics, Alger Pediatrics, Cherry Street Health Center, Forest Hills Pediatrics, Grand Rapids Pediatrics, Helen DeVos Children's Hospital General Pediatrics Clinic, Kent Pediatrics and Westside Health Center.

The Children's Healthcare Access Program is modeled after successful programs in Colorado and North Carolina. First Steps will evaluate the one-year pilot project and hopes to expand the Children's Healthcare Access Program to include more managed care providers, more healthcare providers and more children.

First Steps is a partnership of parents, community agencies, business leaders, healthcare providers, educators, foundations, faith leaders and individuals who are investing in our youngest children to ensure a better future for all. The vision of First Steps is that every young child in Kent County will be ready to succeed in school and in life. The inaugural funders for First Steps are the Frey Foundation, Steelcase Foundation, Heart of West Michigan United Way and Early Childhood Investment Corporation. To learn more, please visit http://www.firststepskent.org/.

Priority Health is a nationally recognized health plan company based in Michigan. It serves a half million members with a broad portfolio of products including commercial and government health plans. A nonprofit dedicated to providing all people access to affordable health care, Priority Health is Michigan's top-rated health plan and ranks eleventh in the nation according to U.S. News & World Report and the National Committee for Quality Assurance. Priority Health employs 1,000 people throughout Michigan's Lower Peninsula with offices in Grand Rapids, Farmington Hills, Holland, Jackson, Kalamazoo, Saginaw and Traverse City. For more information about Priority Health, visit http://www.priorityhealth.com/.

Helen DeVos Children's Hospital is West Michigan's largest children's hospital, serving children and families throughout a 37-county region. A teaching hospital, it includes more than 150 pediatric specialty physicians uniquely skilled in providing medical and surgical care to children in more than 40 pediatric specialties. The hospital cares for more than 7,500 inpatients and 150,000 outpatients annually. Helen DeVos Children's Hospital is committed to caring for children and families with compassion, excellence and innovation.