P0039 - “Bending the Curve” in Medically and Socially Complex Youth: Pilot of Novel Interventions in Children’s Health Care (NICH)

Importance: Contemporary health care reform strives to fulfill the “triple aim” by, 1) reducing costs, 2) improving the care experience, and 3) improving population health. There is great need for such reform in caring for pediatric patients experiencing medical complexity and social vulnerability given that this subset of patients makes up a disproportionately large percentage of total health care utilization and expenditures. Novel Interventions in Children’s Healthcare (NICH), a novel clinical behavioral health program, was developed to address the triple aim for pediatric patients experiencing both medical and social complexity. This study describes initial NICH pilot outcomes.

Methods: Fifteen pediatric patients (1 – 18 years old) with both medical complexity and social vulnerability were enrolled based on the following criteria:
1. High risk of repeated and avoidable hospitalizations for health stabilization.
2. Poor response to standard medical and behavioral health interventions unexplained by natural disease progression as identified by their primary providers.
Majority diagnoses were Type I Diabetes and Cystic Fibrosis, mean age was 14.1 (SD=4.46) years old, 60% of patients were female, and all patients experienced one or more types of social vulnerability including, but not limited to, truancy, single-parent household, or parental substance abuse. All patients were covered by the same state Medicaid provider. NICH services were delivered for an average of 12 months and included (1) strategic family and systems interventions, (2) health systems integration and patient needs alignment, and (3) improved resource access for family and patient. NICH providers (MA or MPH trained) were available to patients and their families remotely and in-person 24 hours a day, 7 days per week and delivered services in real time at the academic medical center and in patient’s homes and communities. Per member-per month (PMPM) healthcare costs, ED visits, hospitalizations, hospital length of stay, disease specific health outcomes, and office visit no-show data were collected during the year prior to and following program enrollment.

Results: Participants exhibited on average a 13.4% reduction in unique ED visits, 48.7% reduction in hospitalizations, 59.3% reduction in length of stay, 34.9% reduction in office visit no-shows, and 48.3% reduction in average PMPY costs ($4,647 to $2,243) during the intervention when compared to the year prior. A sub-analysis of Type 1 and Type II Diabetes patients evidenced an average 3.7% reduction in HgB A1c and 100% reduction in DKA events. No patients were withdrawn from the intervention.

Conclusions: Data from this pilot suggest that a multisystem behavioral health intervention emphasizing 24/7 care coordination and support can decrease healthcare utilization while improving health outcomes and the care experience for pediatric patients with both medical and social complexity. Further study is required to examine confounders and identify the most efficacious elements of the intervention.