eNEWSLETTER
Volume One, Issue 3
- CareAssist's New Pediatric Management Program
- CareAssist Achieves Significant Clinical and Financial Outcomes for Medically Complex Child
CareAssist's New Pediatric Management Program
Coordinates Care for Complex Pediatric Conditions and Improves Clinical and Financial Outcomes
Clinical management of critical pediatric care is becoming more complex and costly. Children with serious conditions are fragile and require specialized expertise from multiple specialists. The Assist Group has introduced the new CareAssist Pediatric Management Program, bringing our renowned expertise in care management to a new arena. Inspired by the successful CareAssist service for maternity and complex newborns, the Pediatric Management Program is designed to improve outcomes for a host of pediatric conditions, including cancer, congenital anomalies, trauma, and rare syndromes. CareAssist works to identify and resolve key medical issues impeding progress, accelerate care and offer innovative evidence-based solutions to difficult problems.
Children admitted for pediatric illness have a longer than average length of stay and higher per diem cost than neonates, according to the Agency for Healthcare Research and Quality, averaging almost $3,000 per day. To enhance clinical and cost outcomes for critically ill children, their families and payers, the CareAssist Pediatric Management Program integrates pediatric care management with financial claims analysis and resolution, facilitating superior outcomes and bottom line results.
Each case is assigned an expert team, including a pediatric nurse care manager and physician specialist who works with the child's treating team to ensure high quality, appropriate care. Our team of experts evaluates each case individually and works collaboratively with the child's care providers and family to implement an outcome-driven care management plan.
Our specialists follow up with the treating team to evaluate progress and update the care plan. In addition, our specialized nurse care managers work with the family to provide education and resources and support decision making.
The CareAssist Pediatric Management Program's comprehensive, collaborative team approach is designed to produce optimal results for critically ill children, families and payers. The program can be customized to meet each payer's care management requirements, including referral criteria, communication and reporting, resource allocation and outcome measures.
For more information on the CareAssist Pediatric Management Program, please contact Beverly Skram at 877-631- 9080 or visit us online at www.assistgroup.com
CareAssist Achieves Significant Clinical and Financial Outcomes for Medically Complex Child
Case Study: Mathew, 33 months old
Issues
Down's Syndrome child - History of Tetrology of Fallot repair, atrioventricular canal type ventricular septal defect and chronic respiratory failure - Continued feeding intolerance requires use of G-tube - Recurrent low blood pressure and infections – At time of referral, in PICU for 46 days - At same facility for 33 months – No plan for discharge.
Results
Five weeks after referral, Mathew was discharged home with his medical condition stabilized and home care in place.
At the time of referral, Mathew was 33 months old and had been in the Pediatric Intensive Care Unit (PICU) for 46 days. He had been a patient at the same facility for 33 months. The previous case management company managed the case for approximately one year and was unsuccessful in facilitating his discharge home.
Mathew is an extremely medically complex child with recurrent infections and low blood pressure that contributed to his prolonged length of stay. CareAssist provided the clinical expertise of a pediatric intensivist as well as a highly experienced pediatric care manager. Key clinical issues were quickly identified that prevented discharge. By effectively communicating with the treating team, the recurrent medical complications were resolved and there was a return to baseline stability. Discharge planning was then resumed to ensure a timely and smooth transition home.
In order for the discharge to be successful, it was essential that a home care agency be coordinated prior to discharge and Mathew's mother be thoroughly trained and educated in his complex care needs. While a home care agency had been identified, at the time of referral it was uncertain if they were Medicaid certified. CareAssist contacted the home care agency and determined the agency was Medicaid certified and identified when staffing could begin.
CareAssist also maintained close contact with Mathew's mother to provide education and support through the discharge and transition home. We ensured that Mathew's mother was educated, trained and comfortable with the home care routine and the agency exhibited competency in Mathew's complex medical condition.
There were multiple agencies involved in this case. Without a single organization providing continuity of care and coordinated case management, there was an increased risk for continued delay in discharge. CareAssist maintained communication with Mathew's Medicaid case manager as well as the home health care agency to ensure continuity of care from hospital to home. This resulted in a timely and successful discharge home with home health care in place.
CareAssist managed this case for five weeks. During this short period of time, our experts resolved the key medical and home care issues that had led to a prolonged inpatient confinement of 34 months. CareAssist provided continuity of care and a level of communication which allowed for Mathew to reach baseline stability. Additionally, CareAssist facilitated the necessary preparations with Mathew's mother and the home care agency for discharge home.
Without CareAssist's involvement in this case, Mathew would have likely remained in the hospital for an extended length of time and been at risk for serious and potentially life threatening clinical problems. We were successful in reducing the length of stay and costs, mitigating further clinical issues and supporting the family's desire to care for Mathew at home.