Children's Hospital Colorado research argues for use of medical homes in pediatrics

New research from Children's Hospital Colorado (Children's Colorado) argues strongly in favor of the redirection of public funding to invest in improving the use of patient centered medical homes for children with public or no insurance. As defined in Colorado State Statute:

"Infants, children, and adolescents and their families work best with a health care practitioner who knows the family and who develops a partnership of mutual responsibility and trust. Medical care provided through emergency departments, walk-in clinics, and other urgent-care facilities is often more costly and less effective than care given by a physician with prior knowledge of the child and his or her family." Medical homes, according to the recent research, help Colorado kids get the right care, from the right place, right when they need it.

The research was led by James Todd, MD, Jules Amer Chair in Community Pediatrics at Children's Colorado. It found that while the number of children covered by public insurance in Colorado has nearly doubled since 2008, these children are more likely to lack access to consistent primary care than their privately insured counterparts.

The study specifically analyzed 2014-2015 trends in Colorado emergency department (ED) and hospital utilization rates related to children and found that Colorado kids with public or no insurance were 2.4 times more likely to be hospitalized and 4.8 times more likely to visit emergency departments than children with private insurance. Colorado taxpayers could have saved $214,000,000 in Medicaid payments if that care had been delivered in a medical home setting rather than a hospital.

The researchers also determined that families with public or no health insurance appear to utilize primary care, Urgent Care, EDs and hospital care in ways different from those with private insurance. That is, they are more likely to visit EDs for illnesses that can be effectively managed by phone triage or a same/next day primary care visit. In addition, their higher hospitalization rates may be a result of illnesses progressing to a more serious level due to a delay in seeking care.

"The research findings imply that, if publicly insured and uninsured children had access to - and appropriately utilized - a medical home, many emergency department visits could be prevented, resulting in lower costs to public insurers," said Dr. Todd. "This is especially pertinent given the current state of health care because reductions in primary care reimbursement rates locally and possible changes in health care financing nationally will likely do the opposite and further increase emergency department and hospitalization costs."

In order to maximize the suggested benefit of utilizing patient centered medical homes, the researchers recommended three key strategies:

• Offering parents easy access to 24/7, pediatric-focused health management information and phone triage support
• Providing extended office hours for acute primary care (with affiliated ED/Urgent Care backup)
• Ensuring comprehensive, continuous care coordination