Care Management Interventions Effectively Reduce Hospital Visits for Medically Complex, Medicaid-Insured Patients

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Why is this important?

Healthcare systems can be difficult to navigate, especially for children with multiple chronic conditions. It can be difficult to coordinate frequent appointments, providers, and care plans, yet when plans are not coordinated it can lead to preventable illnesses and acute care visits. Care management, a team-based care approach that helps children and their families navigate healthcare systems and effectively manage medical conditions, can increase receipt of recommended care and prevent hospital or emergency department visits. CHOP’s Nicholas and Athena Karabots Pediatric Care Center (Karabots) entered a unique partnership with Keystone First Medicaid managed care health plan to pilot an enhanced care management program for medically complex patients, called Keystone-Karabots Care.

What we did

Our K2C care management team includes nurses, doctors, community health workers, a social worker, and an office administrator. We implemented five new care management activities, including: (1) telephone assessment after unplanned hospital visits, (2) telephone assessment after unplanned emergency department visits, (3) expedited scheduling for yearly well visits, (4) reminders for yearly influenza vaccines, and (5) assessment of unmet needs and referral to social work, if needed. Children also continued to receive standard care management services, such as medication authorizations, communication with outside healthcare providers, and patient education. 

Summary of results

Within 15 months (April 2017- June 2018), over 500 medically complex children were enrolled in K2C care management and received new services. Hospitalization rates for this cohort of patients decreased by 23.4% as compared to rates before K2C enrollment, and reductions have been sustained for over a year. Emergency department visits were similarly reduced.

Updated May, 2020