Clifford Beers Clinic developed an innovative and successful program to better meet the needs of children and families with complex medical and mental health issues, and piloted it using a federal grant. With the federal funds expiring this year, the Connecticut Health Foundation has awarded Clifford Beers a grant to identify ways to sustain the model so it can continue serving children and families.
The grant is one of seven awarded this quarter by the Connecticut Health Foundation, the state’s largest independent health philanthropy.
Clifford Beers Clinic, based in New Haven, developed WrapAround New Haven to focus on families who have complex needs and use significant amounts of health care services. Taking a broad view of the factors that influence health, the model provides care management, mental health treatment, and medical support, and addresses both health care needs and other factors that can interfere with families’ well-being. To address barriers to care and increase the likelihood of promising outcomes, some elements of care were delivered in families’ homes. The pilot, which served 598 families covered by Medicaid, showed promising outcomes: decreased depression symptoms, reduced hospital stays and emergency department visits, and cost savings, particularly among patients with asthma, hypertension, heart disease, serious and persistent mental illness, or severe emotional disturbances. Health care costs dropped by an average of $600 per participant per month after enrollment in the program.
However, care management – the work that made WrapAround New Haven so successful – is not a billable service, meaning it is not paid for in the health care system’s current payment model. As a result, the expiration of the 3-year, $9.7 million federal grant means the model won’t be available to children and families covered by Medicaid unless policy changes are made to make it financially sustainable.
The $55,000 grant from the Connecticut Health Foundation is intended to support Clifford Beers’ work to identify ways to sustain the care management services, including developing a business plan and advocating for changes in how health care is financed. A separate $10,000 grant from the Connecticut Health Foundation will fund market research and financial modeling to support Clifford Beers’ efforts to launch a service line focused on care management for patients with complex needs that could be used by insurers and health systems.
There is already evidence of broader interest in the model. While the federal grant-funded pilot served Medicaid clients, Clifford Beers has reached an agreement with Anthem Blue Cross and Blue Shield to make similar services available to its members.
“Through this innovative model, Clifford Beers has been able to improve outcomes for vulnerable families. It is critical to ensure that promising models like this one can become sustainable so this innovation can benefit Connecticut families,” said Tiffany Donelson, the Connecticut Health Foundation’s vice president of program. “This program also underscores the importance of making sure the health care system pays for quality outcomes and encourages promising practices.”
“For complex patients, addressing their psychological and social needs can be as important as treating their medical conditions,” said Dr. Alice M. Forrester, chief executive officer at Clifford Beers. “All of that must be treated in the context of not simply an individual in a family, but in the context of the entire family. The current payment system is impeding the adoption of effective interventions that account for this whole-family, whole-person approach to care, particularly in high-need, high-cost patients. We know this is a better approach to care and look forward to finding a payment structure that can sustain it.”