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blog9FALL2011GREATSTARTSHEREtissaidthatPresidentLyndonJohnsonstartedMedicaidin1965afterhesawthepoorhealthofyoungArmyrecruitsmanyofwhomwerephysicallyunt.CreatedtoservepoorchildrentheelderlyanddisabledMedicaidhassincegrowntobethemostexpensivepublichealthprograminthenation.Today40percentofallchildreninMichiganareonMedicaidwith51percentofallchildrenbornin2010onMedicaid.DespitegrowingnumbersofMichiganiansonMedicaidduetoarecessionthatcontinuestothrustmorechildrenintopovertyeachyearcutstostateandfederalfundingforMedicaidareonthetable.CompoundthiswiththeveryrealproblemMedicaidfamiliesfacendingphysicianswillingtotreatthem.Below-costMedicaidgovernmentreimbursementratesareasignicantdisincentiveforphysicianstotakeonincreasingnumbersofchildrenonMedicaid.AsaresultMedicaidpatientsoftendonotreceivetheprimarycaretheyneedtostayhealthy.Whenconditionsanddiseasespersistandworsenmanyseekcareincostlyemergencyroomsresultinginhigherratesofhospitalization.HowcanweimprovehealthoutcomesforthesefamilieswhilebeingmindfuloftightgovernmentbudgetsTheKentCountyChildrensHealthcareAccessProgramCHAPlaunchedin2008hasshownitcanbedone.Throughmindfulcollaborationamongpediatricianshealthcareinsurersfoundationsandareaagenciesthisevidence-basedmodelforapediatricmedicalhomeforchildrenonMedicaidisshowingrealsuccess.TheAmericanAcademyofPediatricsAAPhasbeenanationalchampionofpediatricmedicalhomesforthreedecadesinwhichtimeitsdescriptionofwhatamedicalhomeshouldbehasevolved.TodaytheAAPdenespediatricmedicalhomeasaplacewhereallchildrenincludingthosewithspecialneedsreceivecomprehensiveprimarycarethatisaccessiblecontinuouscomprehensivefamily-centeredcoordinatedcompassionateandculturallyeffective.WeknowthatchildrenonMedicaidaretwiceaslikelytobeseverelyilltwiceaslikelytobehospitalizedtwiceaslikelytodiethanchildrenservedbyprivateinsurance.ThatiswhynewsofKentCHAPsevidence-basesuccessissoimportanttousall.KentCountyCHAPhasdemonstratedthatitcanimprovehealthoutcomesbycreatingastructuretosupportphysiciansandhelpfamiliesnavigateacomplicatedsystem.Initsthree-yearhistoryithasdemonstratedimprovementsinaccesstocarebyopeningupnearly2000moreslotsforchildrenonMedicaidsignicantlyreducinginappropriateuseofemergencyroomsby14percentdecreasingthenumberofhospitalizationsby12percentreducingERvisitsby35percentandhospitaladmissionsby68percentamongchildrenwiththemostsignicantneeds.Earlyinterventionandpreventionwereencouragedandsupportedincludingexpansionofasuccessfulasthmainitiativeincreasedimmunizationratesoralhealthserviceschildhoodobesitypreventionandtreatmentbehavioralhealthhealtheducationandadvicetoparents.Arecentindependentcost-analysisoftheprojectindicatedthereturnoninvestmentinCHAPisstrongestimating75percentofCHAPspendingisoffsetbyreducedmedicalspendingonhospitalizationsandemergencyroomvisits.NowexpansionoftheCHAPmodelisunderwayinanotherhighlypopulatedpartofthestateWayneCountyandsoontoberolledoutinSouthwestMichigan.ThenextstepandmilliondollarquestionishowtosustainaCHAPsystem.Canitbedonewithaper-patientfeetocoveradministrativecostssharedbythemanagedcareorganizationthestateorareothernancingmodelsneededThechallengeforusaspediatriciansistoconvincepolicymakersandfundersthatthemedicalhomeisworthadoptingandworthsustaining.TheMichiganChapteroftheAAPiscommittedtoimprovingchildhealthoutcomes.Wenowhaveanevidence-basedsuccessfulmodeltoshowleadersinMichiganthatitcanbedone.KudostoourKentCountycolleagueswhoareleadingthewaytobetterchildhealth.Dr.LawrenceReynoldsIImprovinghealthoutcomesforMedicaidfamilies40ofallchildreninMichiganareonMedicaidwith51ofallchildrenbornin2010onMedicaidLawrenceReynoldsM.D.FAAPistheBoardPresidentoftheMichiganChapteroftheAmericanAcademyofPediatricsandtheCEOofMottChildrensHealthCenterinFlint.