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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Thomas A. Malone, MD, MBA, Children's Choice of Michigan, 1155 Brewery Park Boulevard, Suite 250, Detroit, MI 48207, 313-393-8034, Tmalone@dmc.org
Children’s Choice of Michigan (CCOM) is a qualified health plan for children with special health needs. CCOM offers families an alternative to a traditional fee for service or Health Maintenance Organization (HMO) approach to medical care. CCOM focuses on developing individual health care plans (IHCP) that promote partnerships between families, physicians and community resources. Pediatric sub-specialists, not primary care physicians, develop the IHCP with the families and community representatives. The IHCP becomes the blue print for care management and streamlines the authorization of services for a one-year period. Care management nurses utilize the IHCP to coordinate services across the continuum of care. Conclusions based on experience with 1500 CCOM members from years 2000 and 2001 are: 1) Global age/sex adjusted pediatric capitation rates significantly under fund children with special health needs. 2) Customer satisfaction is significantly higher in the care coordination model than in the traditional HMO model. 3) Families and community resources are under utilized in fee for service and HMO models. 4) Traditional benchmarks for quality of care (hospital length of stay, readmission rates, bed days per 1000) are inadequate measures of quality for this population. 5) Pharmacy and durable medical equipment are high cost services that require complex, individualized, care coordination.
Learning Objectives: At the end of the presentation, the participant will be able to
Keywords: Children With Special Needs, Coordination
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.