Children's receives $2.8 million grant to pilot health care coordination model

June 15, 2012
MILWAUKEE - Children's Hospital and Health System (Children's Hospital of Wisconsin) has been awarded a $2.8 million grant from the Center for Medicare & Medicaid Innovation to pilot a program designed to reduce health care costs and improve quality of care. Children's is creating an Advanced Wrap Network Model (AWN) of culturally sensitive professional, clinical and social resources to educate members of Children's Community Health Plan (CCHP), 45,000-member Medicaid HMO serving southeastern Wisconsin, how to effectively navigate the health care system. CCHP is a member of Children's system.

The AWN will actively be supported by several community organizations, including Sixteenth Street Community Health Center, Kenosha Community Health Center, Wheaton Franciscan Healthcare and Aurora Health Care. These organizations will work with CCHP to promote the model with their patients and will provide workspace within their clinics to allow CCHP staff to personally meet with members.

"We are honored to receive this grant to support our vision to improve the health and well-being of children and families in our community," said Peggy Troy, CEO of Children's. "I applaud CMS in leading the way to encourage new models of care. In our case, with the support of our partners, we intend to increase the use of primary care health homes, reduce avoidable emergency room visits and reduce inpatient hospital admissions for members of Children's Community Health Plan."

"This model of care was created because we all believe we can achieve cost savings in providing health care, while maintaining – and even improving – safety and quality," said Bob Duncan, president of CCHP. "We are committed to helping individuals and families find health homes and reduce avoidable hospital visits by at least 7 percent. While these changes are designed to save millions of dollars, they also will lead to better coordination of services to achieve HEDIS quality metrics around asthma, immunizations, diabetes and lead testing, as well as more satisfied members."

HEDIS (Healthcare Effectiveness Data and Information Set) is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service.

The AWN will specifically target CCHP members who have had two visits to the emergency department within six months or those diagnosed with asthma who have had one visit to the emergency department or one admission to the hospital.

Over a three-year period of the grant, an estimated nine jobs will be created, including nurse and community health navigators. Mark Rakowski, executive director of CCHP, will serve as the grant administrator.

Nurse navigators will provide proactive outreach, guiding CCHP members and providers through the managed care system by providing one-on-one coordination of health care with the goal of promoting appropriate and timely access to services. The goal is for members to receive the right care, at the right time, in the right place.

Community health navigators will work within assigned geographic areas to facilitate care for CCHP members, coordinate social services and medical resources and serve as an additional point of contact for questions and to provide health education.

CMS Center for Innovation

Established by the Affordable Care Act, the Center for Innovation is a new engine for revitalizing and sustaining Medicare, Medicaid and the Children's Health Insurance Program (CHIP), and ultimately for improving the health care system for all Americans.
 
The CMS Innovation Center fosters health care transformation by finding new ways to pay for and deliver care to improve care and health while lowering costs. The center identifies, develops, supports and evaluates innovative models of payment and care service delivery for Medicare, Medicaid and CHIP beneficiaries using an open, transparent and competitive process.
 
The Health Care Innovation Awards are funding up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improve care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs. Awards range from approximately $1 million to $30 million for a three-year period.

The first awards were announced in early May. The second batch of awards were announced today.

About Children's Hospital of Wisconsin
Children's Hospital of Wisconsin is the region's only independent health care system dedicated solely to the health and well-being of children. The hospital, with locations in Milwaukee and Neenah, Wis., is recognized as one of the leading pediatric health care centers in the United States. Children's Hospital provides primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. In 2010, Children's Hospital invested more than $105 million in the community to improve the health status of children through medical care, advocacy, education and pediatric medical research. Children's Hospital achieves its mission in part through donations from individuals, corporations and foundations and is proud to be a Children's Miracle Network Hospitals. For more information, visit the website at chw.org.