An Innovative Care Coordination Delegation Model to Strengthen the Medical Home and Improve Outcomes

This slide deck describes the unique delegation arrangement that Children’s Comprehensive Care shares with BCBS STAR Kids (Managed Care Organization) to deliver service assessment and service coordination by the RN case manager at the medical home. The delegation funds non-billable case management services and integrates the assessment and service coordination within the medical home. Originally presented at the Pediatric Academic Societies Meeting.

Texas HHSC approved Summary of Service Coordination

Children’s Comprehensive Care (CCC) summarizes the responsibilities of both the medical home (CCC) and the MCO (Managed Care Organization) for the delegation of service coordination tasks. Prior to the MCO committing to reimbursing the medical home for service coordination tasks, they wanted HHSC to approve the arrangement.

Complex Care Program Brochure

Part of a ‘new to program’ packet sent to new complex care program patients/families several weeks ahead of their first complex care program clinic visit.

Complex Care Program Welcome Letter

Part of a ‘new to program’ packet sent to new complex care program patients/families several weeks ahead of their first complex care program clinic visit.

HRSA Meeting Presentation Slides for the SPNS initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations

On June 27, 2017, the grant recipients of the Special Projects of National Significance (SPNS) funded initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations convened a day-long meeting to present results to staff from the U.S. Department of Housing and Urban Development (HUD), Health Resources & Services Administration (HRSA), and Substance Abuse and Mental Health Services Administration (SAMHSA). They presented the strategies that collectively led to more than 1,300 people nationwide being served over the five-year initiative.

HRSA Meeting Posters for the SPNS initiative – Project Overview Poster: Multisite Results from the initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations PDF

For a HRSA meeting on June 27, 2017, each SPNS demonstration site created a poster presentation outlining the model that was developed as part of the initiative Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations. Each poster includes findings, successes and challenges and next steps.