Achieving Medical Home Certification within a Coordinated Care Entity (CCE)

Background: In response to a changing healthcare environment, Ann & Robert H. Lurie Children’s Hospital of Chicago has implemented several new models of care delivery to provide high value care. In 2014, Lurie Children’s was named one of two CCEs for children with complex medical needs in Illinois. Uptown Primary Care, one of Lurie Children’s primary care center at Lurie Children’s, is the medical home for pediatric patients with complex medical needs. To provide the highest quality coordinated care, Uptown applied for National Committee for Quality Assurance (NCQA) Patient Centered Medical Home Certification (PCMH).

Methods: Uptown has a long standing history of providing high-value care for its patients. PCMH certification has strengthened Uptown’s model of care coordination and quality improvement initiatives. As a result of the application, guidelines were expanded to include preventative care reminders for patient care plans in adherence with American Academy of Pediatric standards. Quality initiatives were created focused on patients with chronic illness or those who are highly medically complex.

Results:  Early data shows a 15.7% decrease in payments per Illinois Medicaid recipient compared to state averages for medically complex pediatric patients. In 2014, the number of patients who received their appropriate 15 month well child care visit increased by 6.3% and the number of patients with a documented asthma control test increased by 9%. In the same year, patients with ADHD tracked for appropriate follow up increased by 38.8%. 

Conclusions: The care delivery model at Uptown has proven to reduce healthcare costs, while improving outcomes.