AT-HOME CARE FOR CHILDREN
Coordinating care providers, services and supplies for children with complex, chronic medical problems creates challenges for parents equal to those of the care itself. And state agencies that try to help often face the related issue of cost-effectively providing these families with high quality long-term care services from many providers. Community Case Management (CCM), a partnership of UMass Medical School’s Commonwealth Medicine division and MassHealth, the state’s public health insurance program, creates a single point of entry for services to these families.
CCM was initiated in 2003 through a pilot program with MassHealth; the pilot was in response to a shortage of visiting pediatric nurses that resulted in children being treated in intensive care units rather than at home. An immediate success, CCM became a full-fledged program in 2006 that now serves almost 600 families.
Throughout Massachusetts, families with medically fragile children struggle to care for them at home. The state asked UMass Medical School to pilot a program to respond called Community Case Management (CCM).
CCM is the single point of contact for families, providing coordination of medical services, benefits and equipment. Emergency room visits and hospitalizations of these children have been reduced as a result.
CCM professionals understand the latest equipment, techniques and coverage available to medically complex cases. Their efficiency brings cost savings to Massachusetts—more than $5 million each year when third-party payments are applied before MassHealth.
Upon referral, each family is visited by a CCM nurse case manager authorized to approve and coordinate MassHealth services. The case manager assesses the family situation, home environment, medical and other care needs and private insurance availability, then approves services in consultation with a pediatrician, pharmacist, social worker, and physical, occupational, respiratory and speech therapists.
Renee Reitano’s daughter was diagnosed with metachromatic leukodystrophy at age three. “One of the greatest benefits of CCM is that it has made our family organized, which is so crucial with a child with a horrendous disease. It’s physically impossible to do it all,” said Reitano (pictured with her daughter in background above). “Having someone here with us, I’ve been able to start a foundation to help eradicate the disease.”
With this sort of medical intervention—and innovation—many chronically ill children are living longer, and larger numbers of critically ill premature infants are surviving, according to CCM Medical Director Julie Meyers, MD, assistant professor of pediatrics at UMass Medical School. CCM’s Nurse Liaison program brings nurses to neonatal intensive care units to help medically complex newborns make the transition from hospital to home, while two CCM nurse case managers specialize in transitioning older adolescents to adult service programs.
“Families are incredibly pleased to have one person who knows their child well. With CCM, the family doesn’t have to coordinate care; they can just love and care for their medically fragile child,” said Dr. Meyers. “We help parents be parents.”
Community Case Management
This information originally appeared in Partners In Service, which was published by UMMS in 2008. PDF available.