Yousuke Horikawa, CHOC Children's Hospital of Orange County, Orange, CA, United States; Elizabeth Grant, CHOC Children's Hospital of Orange County, Irvine, CA, United States; Amber Morlan, CHOC Children's Hospital of Orange County, Orange, CA, United States; Michael Weiss, CHOC Children's Hospital of Orange County, Orange, CA, United States
Senior Medical Director CHOC Children's Hospital of Orange County Orange, California, United States
Background: Pediatric care coordination and management have been shown to improve appropriate healthcare utilization in medically complex Medicaid patients. In a fully capitated payment model significant savings can be achieved, greatly outweighing the needed resources to implement these programs. However, there are very few studies that have examined the value of case management in the commercial payer arena and where patients do not have medically complex diagnoses. Objective: To Identify the impact of pediatric care coordination on overall utilization and patient satisfaction. Design/Methods: Children’s Hospital Orange County (CHOC), in collaboration with a commercial payer, enrolled 172 patients in a care coordination program between April 2020 and January 2024. These patients were assigned a Lead Care Coordinator and Nurse Case Manager from CHOC, and a Commercial Insurance liaison from the payer. An interdisciplinary care team meeting was convened and a care plan was co-created with the team and the parents. Goals of care, care coordination and management were provided by the CHOC team. Inpatient and specialist utilization and overall claims data were then monitored at 30, 60, 90, 180, and 365 days after enrollment into the program. A satisfaction survey was provided to the parents and primary care provider. Results: Five patients were removed from the dataset as they were identified as outliers due to the complexity of their illness and care. Overall, utilization was significantly decreased. Inpatient utilization decreased by 76.1% at 90 days and 21.7% at 365 days. Specialist utilization increased 10.4% over the first 30 days as patients were re-establishing their care due to CHOC coordination efforts. However, at 90 and 180 days there was a 4.2% and 7.8% decrease in utilization, respectively. There was a 43.5% increase in utilization at 30 days, but at all other time points a significant reduction in overall claims, (range: 25.5%-55.5%). was observed. Satisfaction survey results suggested patients and their families felt their care improved with CHOC care coordination.
Conclusion(s): Pediatric care coordination is essential to improving health care delivery regardless of the underlying illness or disorder. When focused care coordination is implemented, utilization is significantly reduced and patient satisfaction is improved. By working collaboratively on care coordination, we can reduce unnecessary resource use and, ultimately, improve pediatric clinical care outcomes.
