Center for Innovation in Social Work and Health to Spearhead Nationwide Multidisciplinary Initiative to Advance Care for Children with Medical Complexity

Boston (Sept. 1, 2017)The U.S. Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau has awarded the Center for Innovation in Social Work and Health (CISWH) at the Boston University (BU) School of Social Work funding to lead a project aimed at testing and spreading innovative care delivery and payment models for children with medical complexity (CMC).  The Collaborative Improvement and Innovation Network (CoIIN) to Advance Care of Children with Medical Complexity (CMC) aims to improve the quality of life for children with multiple chronic and severe conditions, improve the well-being of their families, and increase the cost-effectiveness of their care.

Children with medical complexity (CMC)—defined in this project as those who have “multiple significant health problems that affect multiple organ systems and result in functional limitations, high health care need or utilization, and often the need for or use of medical technology”— comprise approximately 0.6% of all children in the U.S. Their high health care utilization accounts for a significant percentage of pediatric health care spending. They rely on costly services and supports from a variety of providers, and their care needs are long term. Yet these children experience comparatively low-quality health outcomes.  Their families are often left to fill in the gaps of a fragmented system of care, resulting in financial hardship and medical debt, reduced employment among caregiving parents, and increased stress on the entire family.

The Collaborative Improvement and Innovation Network (CoIIN) model promoted by the Maternal and Child Health Bureau provides a framework for multidisciplinary teams of federal, state, and local leaders to work together to tackle a common problem. Ten interdisciplinary state teams, comprising Title V Maternal and Child Health Program and Medicaid leaders, families raising CMC, health care providers, and other stakeholders have been identified and organized to form a CoIIN dedicated to improving health care delivery and payment for CMC.  These ten state teams from Alabama, Colorado, Indiana, Kentucky, Massachusetts, Minnesota, Oregon, Texas, Washington and Wisconsin will receive guidance from CISWH and a National Advisory Committee of experts in an array of relevant fields. Technical assistance, training and coaching will be provided by nationally respected collaborative partners, including the American Academy of Pediatrics, Population Health Improvement Partners, Health Management Associates, the Association of Maternal and Child Health Programs, and Family Voices.  Randall Ellis, PhD, a health care economist at the BU Department of Economics and Christopher Louis, PhD, a health policy expert at the BU School of Public Health, will provide support and guidance to state teams as they develop their plans to test alternative or innovative payment models, as well as econometric analysis of data.

Over its four-year implementation period, the CoIIN model will be used to accelerate the speed at which participating state teams develop, implement, and test new and innovative care delivery strategies and payment models for CMC. State teams will continuously share data to learn from each other’s quality improvement efforts. At the end of four years, CoIIN teams will have improved outcomes for the population, identified replicable care delivery and payment reforms, and developed methods to disseminate and spread them.

Meg Comeau, M.H.A., principal investigator for the project, is a nationally recognized expert on health care financing policy for children with special health care needs. Co-principal investigator on the project is Sara S. Bachman, Ph.D. director of CISWH, the Paul Farmer Professor at BU School of Social Work and Research Professor at BU School of Public Health. Through their leadership of the Catalyst Center, the national center for health insurance and financing for children and youth with special health care needs, Comeau and Bachman have built collaborative relationships with family leadership organizations, public health agencies and Title V programs, state Medicaid and CHIP programs, state legislators, staff at the Maternal and Child Health Bureau, health plans, and national child health policy and advocacy organizations over the last decade. They will leverage these partnerships to guide the collaboration toward innovative approaches to improving care for CMC.

“This project brings innovators and stakeholders from multiple perspectives together to focus on solutions that can improve the lives of children with medical complexity and their families,” said Comeau. “Strong family involvement is written into the design, implementation, and evaluation of our activities and those of the state teams. The time is ripe to learn more about the unique needs of CMC and then work with families, providers and payers to develop innovative solutions that move us towards a more equitable and cost-effective system of care that results in better health outcomes for children and increases the well-being of their families.”

“We hear a lot about ‘achieving the Triple Aim’—reducing costs, improving population health, and increasing quality and satisfaction for people with chronic, complex needs,” added Bachman. “But most of the attention to date has generally been focused on adults, who comprise a larger population and so cost more overall. The opportunities to improve are wide open, the potential for positive impact is significant, and the cost of not doing so is high for all stakeholders, but especially for children and families.”

See the Collaborative Improvement and Innovation Network to Advance Care of Children with Medical Complexity project page for more information.

This project is supported by HRSA of the U.S. Department of Health and Human Services (HHS) under grant number UJ6MC31113-01-00, Health Care Delivery System Innovations for Children with Medical Complexity, $2,700,000.  This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.