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By Brenda Brissette-Mata
KENT COUNTY -- For long-time pediatrician Dr. Thomas H. Peterson, seeing the published results of his early childhood health disparities study closed the loop on a body of work that began in 2001.
The study, funded by the Early Childhood Investment Corporation and Kent County Great Start Collaborative, has been published in The Journal of Pediatrics.
The significant disparities in outcomes shown in the study, such as higher rates of admissions, mortality, asthma, and many other diseases in publically insured children versus commercially insured, became the galvanizing force behind the creation of Kent County Children’s Health Access Program (CHAP).
CHAP is operated by First Steps, a community-based early childhood nonprofit organization that works closely with the Kent County Great Start Collaborative.
The program is aimed at improving the health outcomes of children on Medicaid while better utilizing existing resources and decreasing costs. In the first year of the project, emergency room visits for publicly insured children declined as did in-patient hospital admission. CHAP estimates annual savings to the state could be nearly $200 million if publicly insured children had hospitalization rates similar to privately insured children.
CHAP’s primary goal is to ensure that every child in Kent County has a quality medical home and a team approach to providing health care. The simplest explanation is that a medical home is the primary care provider, where a child goes for immunizations and well-child visits. Physician quality medical home keeps the child’s records, knows his or her health history, and coordinates the child’s care.
Maureen Kirkwood, program manager for Kent County CHAP, said that the study , entitled “Insurance Associated Disparities in Hospitalization Outcomes of Michigan Children,” was modeled after a similar study that had been conducted in Colorado prior to the creation of the Colorado CHAP.
“We wanted to see if the results in Michigan would be any different.”
In fact, the results turned out to be very similar, even though the service delivery mechanism for Michigan Medicaid is quite different from Colorado.
Kirkwood explained that in Michigan, managed care plans are involved in the delivery of care to children enrolled in Medicaid. In the case of Kent County CHAP, the county’s largest locally-based health plan, Priority Health, became a founding partner of CHAP.
A key factor in CHAP’s early success is that Priority Health agreed to pay participating physicians an enhanced Medicaid reimbursement rate in exchange for opening to additional Medicaid patients. In addition, Priority developed a “pay-for-performance” incentive structure to reward certain CHAP clinics for improving child health outcomes and lowering ER and inpatient rates.
“I think the fact that we have three other major counties (Wayne, Kalamazoo and Genesee) interested in having their own Children’s Healthcare Access Program shows that we have had some success, but it is still just the beginning, and the work never ends,” Peterson said.
For Peterson, Executive Director of Safety, Quality and Community Health at Helen DeVos Children’s Hospital, and also medical director of Kent County CHAP as well as others involved in the Kent effort, it is nice to see the results that initially provided the impetus for the program finally published in a national journal. The study’s team also included his son, Tom Peterson, now in medical school at Michigan State University, and the lead author on the article.
Kirkwood believes the study shows citable results. “Our hypothesis was that part of the disparity between kids on Medicaid and kids on private insurance was caused by a lack of access to a quality medical home,” she said. “This study galvanized our board, funders, and community to implement CHAP.”
The Kent County CHAP program is gaining national attention. The Agency for Health Research and Quality, a part of the U.S. Department of Health and Human Services and the lead agency charged with supporting research designed to improve the quality of healthcare, also published a profile of the program.