O2181: 12-Month Outcomes of a Virtual-First Population-Tailored Multi-Disciplinary Comprehensive Care for CYSHCN and CMC

Background: Children and youth with special healthcare needs (CYSHCN) are “those who have or are at increased risk for a chronic condition and require health and related services of a type or amount beyond that required by children generally,” a broad definition applicable to ~ 20% of children nationally. Children with medical complexity (CMC) have complex chronic medical conditions, experience the most intensive healthcare needs, and often need medical technological devices to improve or sustain life and daily function. While these children represent < 1% of the child population, they account for almost one-third of all pediatric health care costs. The value of telehealth to improve access to care, reduce travel burden, enhance care coordination, and reduce healthcare costs is well-documented. Based upon outcomes of a single-site wraparound virtual care program for CMC, we entered a population-based financial arrangement with three managed care Medicaid payors in two states to deliver a virtual-first multidisciplinary comprehensive care (VFMDCC) program for CYSHCN and CMC. We report 12-month demographic, process, and outcome measures to update previous scientific dissemination.

Methods: We established a VFMDCC program for CYSHCN and CMC to provide acute and longitudinal medical care, behavioral health care, care coordination, and support for non-medical drivers of health virtually. Payors attributed patients to the program using an adapted version of the pediatric complex chronic condition classification system. During an “outreach” phone call, families “enroll” by downloading our app. Providers conduct an “onboarding” (establish care) virtual visit, and patients’ RN virtual visits are scheduled based on a risk assessment score. Following “enrollment,” patients/families are afforded ready access to providers, behavioral health therapists, nurses, clinical team assistants, pharmacy team, dietitians, social workers, and pediatric-trained EMTs (for in-person visits when necessary in eligible regions) via digital in-app chat messages or phone call. We collected patient demographic data, process measures (“attributed”, “enrolled”, and “onboarded” patients; digital, virtual, and in-person visits; chronic conditions and technology dependence), and outcome measures (UC/ED visits/inpatient admissions; total cost of care). This study is deemed exempt by the University of Houston Institutional Review Board.

Results: Table 1 depicts patient demographic data and process measures, including patient VFMDCC status and engagement. Using claims and healthcare utilization data we assigned patients to “cluster” cohorts. The VFMDCC program prevented 1362 UC/ED visits (1/2023 - 12/2023) and decreased per-member-per-month cost of “enrolled" patients by 15% (1/2023 - 6/2023).

Conclusion: We report 12-month demographic data and process and outcome measures demonstrating our VFMDCC’s significant impact on healthcare utilization for CYSHCN and CMC. Our next steps entail tailoring care for CYSHCN and CMC in each “cluster” to best meet their healthcare needs and spearheading a quality improvement initiative to collect and document accurate race/ethnicity data to inform investigation of health equity outcome.