Austin Clinic Tests Effectiveness of Coordinating Care

It takes a team of medical specialists and therapists to care for Anna Barkhuizen, a 9-year-old with epilepsy, cerebral palsy and significant developmental delays. Her mother, Rebecca Barkhuizen, recalls waiting for hours in exam rooms and leaving before seeing the doctor, because Anna had grown too impatient. On one occasion, a new pediatrician offered to give Anna — who does not speak — vaccinations without first asking about her medical history or the medications she was on. 

“I felt like we had all of these dots with all of these specialists, but no one to connect all these dots for us,” Rebecca Barkhuizen said. “Now, I feel like I have a partner in raising Anna.”

For the last year, Anna has participated in a pilot program at the Seton Children’s Comprehensive Care clinic at Dell Children’s Medical Center of Central Texas in Austin. The three-year pilot program, now in its second year, coordinates care for medically needy children, providing access to pediatric physicians, medical specialists and behavioral health care, while offering support services for siblings and parents The program’s founders hope comparative data collected from the pilot and routine outpatient care will show that centralized coordination improves the quality of care, while cutting costs.

“Typically, you put everybody through the same rigid system, and it’s not necessarily efficient or effective,” said Dr. Rahel Berhane, the medical director of the clinic. “The hypothesis is that this is much more cost-effective, so Medicaid would be able to serve more patients.”

Dell Children’s Medical Center hopes to expand the $1.5 million annual pilot program, which is financed through the Seton Healthcare Family, and has applied to receive $18 million through a federal Medicaid waiver that Texas received in 2011. The waiver allows the state to invest nearly $10 billion in federal and local financing to transform health care delivery across the state. More than 1,300 projects have been proposed, and federal approval for projects is expected to come in May.

The program has 130 medically needy children participating, with three-quarters of them enrolled in Medicaid. Half speak only Spanish.

Preliminary data from the clinic shows the program has halved the rate of expensive emergency room visits for these children.

“This project is a good example of how the waiver intends to help children and their families by improving how we deliver critical and comprehensive health care, while at the same time reducing inappropriate visits to the emergency room,” said Linda Edwards Gockel, a spokeswoman for the Texas Health and Human Services Commission, which runs Medicaid, in an email.

Medicaid does not reimburse providers for coordination services, such as the time spent contacting medical specialists or counseling on how to integrate a disabled child at school. But if the pilot program receives federal approval to participate in the waiver program, expenses not traditionally reimbursed by Medicaid could be reimbursed. 

Berhane said important lessons learned in the program’s first year could be instituted across a wider population if the program receives financing through the waiver.

For example, in the early stages of the program, Spanish-speaking parents were still using the emergency room without first calling the clinic’s 24-hour hotline. When the hospital set up a translation service, the emergency room visits declined.

“Since we’ve been going to this clinic, it’s just been an answered prayer,” said Rebecca Barkhuizen, saying the clinic helps her navigate the Medicaid system by contacting Anna’s specialists, ordering her prescriptions and helping her apply for necessary medical equipment. “It’s become her one-stop shop for medical care.”