• New model of integrated care is expected to improve health outcomes and lower healthcare costs by addressing social factors that impact health, coordinating services, and reducing avoidable emergency department visits and hospitalizations
  • Initiative will serve youth living in under-resourced neighborhoods in Chicago

Newswise — Ann & Robert H. Lurie Children’s Hospital of Chicago is one of only eight recipients in the United States to receive up to $16 million, seven-year award from the federal Centers for Medicare and Medicaid Services to develop Integrated Care for Kids – a new model of care that will aim to improve health outcomes and reduce costs of care for children covered by Medicaid and Children’s Health Insurance Program (CHIP).

As the lead organization, Lurie Children’s, in partnership with the Illinois Department of Healthcare and Family Services (HFS) and many neighborhood organizations, will create a socially and clinically integrated network to serve 43,000 children, up to 21 years of age, living in the Belmont Cragin and Austin neighborhoods in Chicago (zip codes 60639 and 60651). The network will bring together local pediatricians, specialists, behavioral health providers, and community organizations and institutions to address the medical and social needs of children and their families.

“This is an exciting opportunity to have a very positive impact on the health of children living in some of Chicago’s under-resourced neighborhoods,” says Tom Shanley, MD, President & CEO of Lurie Children’s. “Through collaboration and coordination with numerous clinical and social service providers, this partnership can create a transformative model of value-based care to improve the health and well-being of children.”

In its recent community health needs assessment, Lurie Children’s found that social influencers of health, including poverty, education, family employment, housing insecurity and food insecurity substantially contribute to the health status of youth in Chicago.

“Addressing the social factors that affect health is one of our top priorities for improving child health in the community. This award will help build community capacity to integrate social programs into a comprehensive approach to healthcare,” says Project Medical Director Matthew Davis, MD, MAPP, Senior Vice President & Chief of Community Health Transformation at Lurie Children’s and Interim Chair of the Department of Pediatrics at Northwestern University Feinberg School of Medicine. “We will focus on early identification of children’s physical, behavioral and social issues and rapidly connect families to appropriate local services. Our goals are to improve health outcomes and to reduce avoidable hospitalizations and emergency visits for children.”

In the new initiative, Service Integration Coordinators will ensure that health and social needs assessments are completed and children have access to the network resources. A new project-focused system will be developed to connect participating organizations and providers, manage interagency referrals, share assessments, and collect and analyze data to drive further improvements to the initiative.

“The integrated network will create enhanced communication and coordination between different agencies to remove the hurdles that families face when trying to access various services,” says Project Director Chris Haen, who also is the Executive Director of Health Partners Care Coordination at Lurie Children’s. “We need to care for the entire family for children to be healthy and achieve their full potential.”

The integrated care model is expected to lower healthcare costs by addressing medical, behavioral and social issues early and in a coordinated manner. The network will operate using a shared savings payment model, distributing savings from decreased healthcare spending among the clinical and social services providers.

“Our team looks forward to continuing to work with Lurie Children’s and their partners on innovative models of care,” says Theresa Eagleson, Director of Illinois Department of Healthcare and Family Services. “It is important that we come together to better serve the children and families at highest risk, improve health outcomes and reduce Medicaid costs.”

In addition to Lurie Children’s and Illinois HFS, representatives from various sectors will participate as a Partnership Council to advise the initiative and promote coordination and integration. They include:

Cares Line

Catholic Charities

Chicago Department of Public Health

Chicago Public Schools

Community Counseling Centers of Chicago (C4)

Division of Specialized Care for Children (DSCC)

Greater Chicago Food Depository

Illinois Association of Medicaid Health Plans

Lutheran Social Services of Illinois

Metropolitan Family Services

North West Side Housing Center

PCC Wellness

Youth Outreach Services

Parents from the community

Lurie Children’s is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Lurie Children’s provides services to more children covered by Medicaid than any other hospital in Illinois. Last year, the hospital served more than 220,000 children from 48 states and 49 countries.

The project described is supported by Funding Opportunity Number CMS 2B2-20-001 from the U.S. Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.