Kalamazoo readies for Children’s Healthcare Access Program to provide low-income children with medical homes

Editor's note: The Early Childhood Investment Corporation has supported the efforts of Michigan communities to implement a Children's Healthcare Awareness Program (CHAP). Nationally, CHAP fits into the broader efforts related to improving access to quality care for vulnerable children.  In Michigan, CHAP works exclusively with children on Medicaid and helps them access quality health care using a more efficient system. Good health is essential for school readiness, an issue that is central to the work of the Investment Corporation.

MLive, KALAMAZOO – A discussion with a colleague a few years ago about how to better help kids who are below the poverty line, led Dr. Thomas Akland, a pediatrician who works for Borgess ProMed Pediatrics and Borgess Family Medicine in Plainwell, to spearhead an effort to start the Children’s Healthcare Access Program in Kalamazoo.

A pilot program of CHAP, which has already taken root in Kent and Wayne counties, has started here with in-kind support from Borgess Health and Bronson Healthcare Group, the dedication of space and resources by Kalamazoo Community Mental Health, and volunteer participation by many others.

“Poor kids have much different health outcomes,” said Akland. “They’re sicker. They have a higher morbidity rate and a higher mortality rate when they show up at the hospital.”

That may be the result of being unable to see a doctor the same day they become sick because they are unable to quickly schedule an appointment, or because they lack transportation to get there, or because they lack money for needed medicines, he said.

They include children who are being raised by siblings or their grandparents and those who don’t always have a safe place to live, said Akland. “Those are the kids that end up missing that turnaround back to good health. They miss more school. Their parents miss more work (to get them care).

They’re not able to take advantage of the rest of the things that our society can provide. They are not able to achieve their full potential, to participate in activities, school sports and other things in lives,” said the pediatrician who has become the local face of a major effort to provide children on Medicaid with comprehensive, high-quality, coordinated health care.

The Children’s Healthcare Access Program intends to provide low-income and Medicaid-eligible children access to “medical homes.” Using a team approach to providing health care, CHAP ensures that a child has a single place for immunizations, well-child visits and care for acute and chronic illnesses and it supports physicians with coordinated care delivered in a comprehensive and culturally sensitive manner.

The goal of CHAP is to increase the community’s overall health “and decrease inappropriate emergency department use at hospitals," according to Akland, by using resources already available in the community.

Jeff Patton, chief executive officer of Kalamazoo Communty Mental health and Substance Abuse Services, is providing the pilot program with a full-time administrator. Dianne K. Shaffer will shift from providing advocacy services for children through Kalamazoo Community Mental Health to wearing many hats for CHAP.

Shaffer is expected to pull together a staff of five at the outset. They will do such things as coordinate transportation for families in need, help plug them into the array of community resources, and find out what pediatricians need to track the care of youngsters on Medicaid.

Akland said the program has also received funding from The Learning Network of Greater Kalamazoo, the Kalamazoo Community Foundation, the Early Childhood Investment Corporation, the W.K. Kellogg Foundation and others. He said the pilot program will need annual funding of $200,000 to $500,000, depending on how large a staff it is able to amass to address the needs of Medicaid families. And it is looking for support from the area's philanthropic community.

“We are not on the primary care side,” Patton said of mental health practices, although he acknowledged there is a big need to coordinate care between different treatment areas. He said he was not proud to learn from Akland and other pediatricians some months ago that their calls to psychiatrists are not often answered. So he said of CHAP, “this is something that came to us … and I think we can really move this forward.”

Patton said Akland’s dedication and his passion for providing care for his patients sold him on participating in the program.

Frank J. Sardone, chief executive officer of Bronson Healthcare Group, said this is a community that really understands that it needs to invest in identifying health and developmental problems of children. And he supports that.

“There is a synergy, a recognition of the importance of early interventions with kids,” he said. Patton and Sardone were among a cross-section of leaders in the health community to see Akland receive an award from the American Academy of Pediatrics for his efforts to get the pilot program started.

The award was presented at Bronson Healthcare’s headquarters by Dr. Jeannette Lia Gaggino, president of the Michigan Chapter of the American Academy of Pediatrics and a pediatrician at Bronson Ramblin Road Pediatrics. 

Gaggino said Akland has done “an amazing job of bringing together many different parties in a truly collaborative effort” and encouraged more support for the effort.

“Dr. Akland has been working tirelessly,” she said, describing a community-wide effort that has been underway for more than two years and has grown into a statewide initiative. “He just keeps hammering away to get this going.”

CHAP has data to support its value of care of its 4-year-old program in Kent County, a 2-year-old initiative in Wayne County and other programs in North Carolina and other states.

A study led by Kent County pediatrician Dr. Tom Peterson and published in early 2011 in the Journal of Pediatrics, estimates that if publicly insured children in Michigan had the same hospitalization rate as privately insured children, the cost savings would be $150 million to $200 million annually.

His study found that children on Medicaid have poorer health outcomes, including: significantly higher hospitalization rates; more severe illnesses resulting in hospitalization; significantly higher rates of respiratory illnesses, such as asthma; more visits to emergency rooms; and higher readmission rates for newborns after discharge from the hospital.