March 28, 2016; Wall Street Journal
Navigating the intricacies of the U.S. health care system is stressful for the millions of patients whose quality of life depends on it. It is common for health consumers to find themselves feeling stranded, left without the assurance of cohesive high-quality and high-value patient care. In pediatrics, where the number of children with complex medical conditions is rising, the need for, and importance of enhanced care coordination cannot be overstated. According to a recent article in the Wall Street Journal, more providers are striving to meet this critical need through the adoption of the complex-care clinic model.
Complex medical conditions generally require a team of medical professionals from various specialties who can address the inner workings of a patient’s multifaceted treatment plan. Regular pediatric offices seldom meet the needs of this patient population, one that depends greatly on “extra time, expertise and resources to maintain a basic quality of life.” To that end, patients—including the nearly 3 million children in the United States diagnosed with a complex medical condition—are not always offered exceptional, coordinated care in primary care facilities. This is due in large part to high costs and human capital that is beyond stretched thin. The complex-care clinic model is one that has been gaining ground as the “go-to” for coordinated care, especially for children facing a lifetime of treatment.
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Those in the health space are not the only ones to recognize the “benefits of complex-care initiatives” as well as the funding needed to supplement their high costs, according to the article. The Advancing Care for Exceptional Kids Act of 2015, aims to improve coordination of care for children on Medicaid with complex medical conditions and reduce the burden on families having to weave their way through a disjointed health care system, among other things. While two-thirds of families that have a child with a complex medical condition are enrolled in Medicaid services, many other families have come to learn the hard way that even with private insurance, health needs relating to complex medical conditions are frequently unmet and uncovered.
Coordinated care efforts are not yet universal or perfected, and they’re not technically new either. In fact, in 2012 Nonprofit Quarterly highlighted the achievements of a successful nonprofit “coordinated care organization” based in Anchorage that serves Alaska Native and American Indian people. Another NPQ piece from 2015 examined the steps certain New York-based nonprofits took in partnership with the state to coordinate preventive care measures with the goal of significantly reducing visits to primary care facilities altogether. But simply providing an array of centralized health care services does not necessarily qualify as an exemplar of coordinated care, especially in regard to care for complex conditions. To deliver true coordinated care, providers must work collaboratively, routinely share information, organize patient care activities and implement thorough follow-up with patients and their families, according to the Agency for Healthcare Research and Quality. This is of particular significance when a young patient experiencing a chronic illness or condition may require a range of specialized physicians, nurses, nutritionists and social workers.
Many agree that care coordination is an effective vehicle to achieve the Institute for Healthcare Improvement’s Triple Aim of improving a patient’s experience while lowering the cost of care, ultimately creating positive health outcomes for populations. Hopefully more entities—practitioners and funders—will start to realize the numerous benefits associated with coordinated care and follow the lead of health care providers like pediatric complex-care clinics. A patient’s care does not start and stop at the doctor’s office; rather, there are myriad other factors that play a role in a person’s treatment plan. And for some of the youngest patients, that treatment plan might very well span the course of their lifetime.—Lindsay Walker