The Texas Tribune: In Coordination of Care, a Partner in Children’s Health

Tamir Kalifa for The Texas Tribune

The Seton Children's Comprehensive Care clinic in Austin coordinates care for medically needy children while offering family support services.

It takes a team of medical specialists to care for Anna Barkhuizen, a 9-year-old with epilepsy, cerebral palsy and significant developmental delays. Her mother, Rebecca, recalls waiting for hours in exam rooms and leaving before seeing the doctor, because Anna had grown too impatient.

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"I felt like we had all of these dots with all of these specialists, but no one to connect all these dots for us," Ms. Barkhuizen said. "Now, I feel like I have a partner in raising Anna."

For the last year, Anna has participated in a pilot program at the Seton Children's Comprehensive Care clinic at Dell Children's Medical Center of Central Texas in Austin. The three-year program, now in its second year, coordinates care for medically needy children, providing access to pediatric physicians, medical specialists and behavioral health care, while offering family support services. The program's founders hope comparative data collected from the pilot program and routine outpatient care will show that centralized coordination improves the quality of care while cutting costs.

"Typically, you put everybody through the same rigid system, and it's not necessarily efficient or effective," said Dr. Rahel Berhane, the medical director of the clinic. "The hypothesis is that this is much more cost-effective, so Medicaid would be able to serve more patients."

Dell Children's Medical Center hopes to expand the program, which gets $1.5 million annually from its parent, the Seton Healthcare Family. It has applied for $18 million through a federal Medicaid waiver that Texas received in 2011. The waiver allows the state to invest nearly $10 billion in federal and local financing to transform health care delivery across Texas. More than 1,300 projects have been proposed, and federal approval is expected in May. (Seton is a corporate sponsor of The Texas Tribune.)

The program has enrolled 130 children, three-quarters of whom receive Medicaid. Half speak only Spanish.

Preliminary data shows that the program has halved the rate of emergency room visits for these children.

"This project is a good example of how the waiver intends to help children and their families by improving how we deliver critical and comprehensive health care," Linda Edwards Gockel, a spokeswoman for the Texas Health and Human Services Commission, said in an e-mail.

Medicaid does not reimburse providers for coordination services. But if the program receives federal approval to participate in the waiver program, expenses not traditionally reimbursed by Medicaid could be reimbursed.

Dr. Berhane said important lessons from the program's first year could be applied across a wider population if the program received financing through the waiver.

"Since we've been going to this clinic, it's just been an answered prayer," Ms. Barkhuizen said. "It's become her one-stop shop for medical care."

baaronson@texastribune.org

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