TX Journey Map Illustration

Team Texas’s journey map illustrated by ConverSketch

Lead Organization

Dell Medical School

Family/Youth Engagement Partner

Texas Parent 2 Parent

Clinical Site

Dell Children’s Medical Center

Project Aims

    • Engage and support patients/families in meaningful ways to promote shared decision-making.
    • Integrate required assessments to minimize duplication and guide development of individualized care plans that inform service delivery.
    • Utilize technology-based tools such as a patient-controlled care coordination platform to promote a shared plan of care.
    • Identify patterns of service/supply usage in the areas of therapy, durable medical equipment, private duty nursing and subspecialist utilization in various subpopulations to maximize efficiency.

Project Description

The CMC CoIIN Texas team, guided by its highly engaged Family Workgroup, is working to design and pilot an integrated care delivery model and develop a dynamic, living “care plan.” Aspects of the model include engaging families to improve care delivery through shared decision-making, comprehensive care coordination, evaluating service/supply patterns, and monitoring related costs. Members of the Family Workgroup hold leadership roles and drive advances in some areas of clinic operations, identifying essential care plan features, and establishing outcome measures that matter to families. The Children’s Comprehensive Care clinic at Dell Children’s Medical Center serves as the site for innovation in Texas. Notably, the clinic utilizes StoryApp, a customizable mobile application developed by Cloud Forest Solutions™, that syncs with the EMR to populate the care plan and provide a best practices repository. StoryApp translates information into Spanish and is available on smartphones. This multifaceted approach is directed to increase the number of improved comprehensive care plans and family engagement in shared-decision making. The Texas CMC CoIIN team includes families of children seen at the clinic, Texas Parent to Parent, practicing clinicians, community providers, policy experts and health system researchers with the Dell Medical School, Medicaid managed care organizations, Texas Medicaid, Texas Title V, and other key stakeholders. The team’s greatest strength is the collective dedication and shared vision among its diverse members for a transformed, family-driven system to support CMC and their families.

Focus Area(s)

    • Family engagement
    • Care coordination
    • Improved access to home care services
    • Alternative payment methods