2. Need for CHAP
Health Net of West Michigan

3. Pediatric Medical Home
“A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.”
American Academy of Pediatrics

4. The Need for MI-CHAP
40% of Michigan children are currently enrolled in Medicaid – up from 23% in 2001
35% of families with children on Medicaid report having difficulty finding providers who will accept their coverage
In 2013, health care reform increased reimbursement for primary care visits from 54% of Medicare rates to 100% of Medicare rates; however, it took almost 18 months for those rates to be funneled to providers.
Children on Medicaid in Michigan and Kent County have poorer health outcomes than children with private insurance
Low Medicaid reimbursement makes it difficult for practices to accept large numbers of children with public insurance
Teaching clinics and FQHCs are overwhelmed by the numbers of Medicaid patients they are asked to see causing more limits to access
Costs due to poor preventive care for Medicaid children are significant in terms of ED use and hospitalization rates
Michigan children with public or no health insurance have poorer health outcomes than privately insured children, including:
Significantly higher hospitalization rates
Higher rates of mortality when hospitalized
More severe illnesses resulting in hospitalization
Significantly higher rates of respiratory illnesses, including asthma
More visits to the emergency room
Higher readmission rates for newborns after discharge from the hospital

5. The Need for CHAP
If the hospitalization rate for children on Medicaid was the same as for those with private insurance, the estimated savings for one year would be $300-$400 million.
Health Net of West Michigan

6. Social Determinants of Health
This slide represents the contributing factors to a person’s health. You’ll notice that Medical Care is only 10% of what makes a person healthy. While we can’t do anything about genetics, we can influence the areas of Environmental Exposure, Social Circumstance and Individual Behavior and this is where the intersection with is most apparent.

7. Social Determinants of Health
Surveying practicing physicians research shows that…
This is where CHAP was born

8. Social Determinants of Health
Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Health Net of West Michigan

9. Examples of SDoH:
Availability of resources to meet daily needs (e.g., safe housing and local food markets)
Access to educational, economic, and job opportunities
Access to health care services
Quality of education and job training
Transportation options
Public safety
Social support
Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
Residential segregation
Language/Literacy
Health Net of West Michigan

10. CHAP Program Elements
Health Net of West Michigan

11. Children’s Healthcare Access Program (CHAP)
Family, Provider, and System Level Changes:
Family:
Care Coordination/Navigation of System
Patient (parent) education
Community Referrals
Transportation
Provider:
TA to improve efficiency & quality
Networking
System:
Increased Access
Catalyst for Change
Neutral convener

12. Family, Provider, System Change
MI-CHAP is a population-based approach to improving health outcomes, raising the quality of care, and reducing healthcare costs for children on Medicaid. A primary goal is to advocate for SYSTEM-Level Reform
Note the three levels within the CHAP model…family, provider and system.

13. CHAP Provides: Patient Services: Parent education regarding:
Appropriate and inappropriate use of emergency department
Importance of child’s medical home
Importance of well child visits, immunizations, lead screening
Referral/ connection to community resources
Care coordination
Navigation of behavioral/ mental health system
Home-based asthma case management/ education
Same day/next day transportation to acute care PCP visits
Interpretation services

14. CHAP Provides Practice Services:
Assistance in decreasing no-show rates
Emergency department use follow-up
Assistance with quality improvement projects, such as improving well child, immunization, and lead testing rates, and other HEDIS measures that may result in incentive payments
Regular practice-specific data reports including ED/1000 and inpatient/1000 rates, HEDIS measures, asthma measures for CHAP-eligible patients
Technical assistance on practice efficiency, scheduling, pediatric triage, throughput, and becoming a family-centered medical home

15. CHAP Provides: Practice Services (cont.):
Education and technical assistance regarding best practices in managing specific health conditions, such as asthma and childhood obesity
Opportunities to network and connect with other pediatric providers, via regular practice manager and provider meetings
Opportunity to participate in community projects/initiatives if desired

16. CHAP Team Kent CHAP’s team:
A local CHAP team is comprised of staff who have varying expertise. This integrated model provides an approach to our work which allows us to address not only health-related issues but broader issues such as Social Determinants of Health (SDoH). Our interdisciplinary team works collectively to address each client’s barriers and provide a path to health equity.
Kent CHAP’s team:
1 - CHAP Manager (LMSW)
2 – LMSW
2 - BSW
1 - Behavioral Health Navigator
5 - CHWs
1 - Practice Engagement Specialist
1 - Program Assistant
2 – Interns (MSW and BSW)
Health Net of West Michigan

17. Kent CHAP Demonstration Project
Target population:
~15,000 children ages 0-17 receiving Priority Health Medicaid in Kent County
Timeframe:
August- December 2008: Ramp up
: 3 Year Demonstration Project
2012: Expansion
Pilot Sites
Private Pediatric Practices
Federally Qualified Health Center- 9 community and school-based clinics
Pediatrics Resident Clinic
Nurse Practitioner Clinic
Total providers: 40 pediatricians and FP’s and midlevel providers
Health Net of West Michigan

18. CHAP’s Triple Aim Outcomes

19. Health Net Case Management
Health Net of West Michigan

20. Case Management Outcomes
In 2015, served 2,177 children and 1,279 adults
Successful contact rate = 82%
2015 ED Reduction Outcomes (pediatric)
19% reduction in overall ED events
44% reduction in ED events among those referred for “Inappropriate ER Use”
58% reduction in ED events among clients with 6 or more ED visits in one year
2015 ED Reduction Outcomes (adult)
15% reduction in overall ED events
Health Net of West Michigan

21. Selected HEDIS Measure & QI Outcomes
24% improvement in children up to date on 0-15 month well child visits (2012)
3-6 year well child visit rate project (2015)
Targeted 145 primarily African American children who had not been seen by PCP
Outreach & transportation resulted in 56% up to date
PCPs received incentive dollars
Health plan met state QI measure
Reduction in monthly no-show rate at family practice from 21% [Oct] to 8% [Nov] (2013)
Health Net of West Michigan

22. Special Projects
Health Net of West Michigan

23. ASTHMA
Intensive home-based case management (partnership with the Asthma Network of West MI)
Education of practices/providers re: best practices in asthma care
Development of practice profiles
Coordination of all “domains” that asthmatic child comes into contact with (school, community, home, PCP, etc.)
Referral to community services (Healthy Homes, etc.)
Data collection and outcomes measurement

24. CHILDHOOD OBESITY Fit Kids 360 Prevention Provider Education
Coordination with Healthy Weight Center at Children’s Hospital
Collaboration with community stakeholders
Advocacy

25. Oral Health Formation of Kent County Oral Health Coalition Advocacy
Improved access to dental services
Increased prevention and education
Grantee of DentaQuest Foundation Oral Health 2020
Health Net of West Michigan