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Caring for children with special healthcare needs in the managed care environment
Michelle R Hawkins1, Beth Diehl-Svrjcek, Linda J Dunbar
1Care Management at Johns Hopkins HealthCare, Glen Burnie, MD 21060, USA.
Insights
A new disease management program effectively coordinates care for children with special healthcare needs, improving outcomes and managing complex conditions like diabetes and sickle cell disease.
Area of Science:
- Pediatric Healthcare
- Chronic Disease Management
- Managed Care
Background:
- Medical advances increase survival rates for children with chronic health conditions.
- Caring for this growing population presents clinical, financial, and satisfaction challenges in managed care.
- Special needs children require specialized care coordination from birth through age 18.
Purpose of the Study:
- To design and evaluate a disease management program for children with special healthcare needs.
- To address the complexities of managing chronic conditions in pediatric populations within managed care.
- To demonstrate program effectiveness through outcome indicators and a dedicated database.
Main Methods:
- Population identification and risk assessment for children with special needs.
- Implementation of coordinated case management interventions.
- Tracking outcome indicators to measure program effectiveness.
- Development and utilization of a specialized disease management database.
Main Results:
- The program successfully identified and managed children with diverse chronic conditions.
- Coordinated care and case management interventions led to measurable improvements.
- Outcome indicators demonstrated the program's effectiveness in improving pediatric chronic care.
- A dedicated database facilitated program function and outcome tracking.
Conclusions:
- Disease management programs are essential for effectively caring for children with chronic health conditions.
- Coordinated care and robust data management enhance clinical, fiscal, and satisfaction outcomes.
- This program model offers a framework for improving pediatric chronic disease management in managed care settings.
Abstract:
Dramatic medical and technological advances over the past 15 years have resulted in the survival into adulthood of children with chronic health conditions. As this population subset has increased, the demand of caring for these children in the managed care arena has become challenging from a clinical, fiscal, and member satisfaction perspective. A disease management program was designed for children, ages birth through age 18, identified as having special needs at the time of birth or at any point throughout childhood related to disease processes such as diabetes, sickle cell disease, genetic aberrations, or the multiple complications of extreme prematurity. Components of the program included identification of the population, coordinated risk assessment, and ongoing case management interventions. Most important, outcome indicators were tracked to demonstrate program effectiveness. The formulation and function of a dedicated disease management database is also discussed.
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