A steady doctor for babies to call their own

Emergency doctors are focused on triage. Small children need a primary care doctor to monitor their growth and give advice to parents, experts say

Inside a converted fruit warehouse near the Grand River in Grand Rapids sit several specialists on the front lines of ensuring that young children get a healthy start in life.

They work for Health Net of West Michigan, a nonprofit community healthcare hub that connects families with doctors and other community services in the Grand Rapids area. One of Health Net’s primary tasks seems simple at first glance – making sure low-income children have a primary care physician.

But connecting kids and doctors is a cutting-edge effort in the fight to support the state’s most vulnerable children from birth to 3 years old, who are in danger of falling behind their peers before they reach kindergarten.

Having a doctor is something many Americans take for granted. But Michigan has an estimated 84,000 children aged 3 and younger who do not have a primary care physician, which means when they come down with a bad cough, high fever or worse, their parents or caregivers take them to a crowded urgent-care facility or a busy hospital emergency room, where they wait while medical personnel tend to patients with more critical issues.

Children’s health experts see that as a problem because emergency rooms are about triage ‒ taking care of the specific problem and sending the patient home.

“There needs to be one person who understands all the connected parts,” said Dr. Kathy Howard, a Grand Rapids pediatrician who is part of the effort in Kent County to link at-risk children to a “medical home” they can call their own.

Treating body and mind

While not yet an everyday term, “medical homes” – another name for a primary care physician – signifies a growing effort in Michigan to connect at-risk children to doctors and other health providers and programs, such as those that screen low-income children for lead poisoning or asthma problems.

Through Medicaid and other health-insurance programs, poor families have received greater access to healthcare coverage in recent years, and experts see the medical homes movement as the next step of an early childhood system that focuses on early learning, mental health, nutrition, family support and early intervention.

That was one of the chief findings of a study on policy options to support children 3 and under that was released late last year by the Citizens Research Council of Michigan and Public Sector Consultants, two Lansing-based research organizations.

“Access to a medical home has been shown to reduce emergency department use, hospital admissions, and overall health care costs, to improve quality of care for children,” the Lansing study said.

One national study, in 2012, demonstrated how medical homes were associated with health-promoting behaviors such as being read to daily, helmet use and decreased television, video game and computer screen time.

A Colorado study documented how the Colorado Children’s Access Program – a medical homes project – resulted in fewer emergency room visits, more preventive-care visits and lower Medicaid costs for children.

Even children who have contact with a variety of medical professionals need their own physician, experts say.

“You may have a variety of therapists, specialists and nutritionists taking care of the child. While they might be experts in their field, they are not necessarily looking at the big picture for the whole child,” Howard said.

The path in Michigan

According to the study by the Citizens Research Council of Michigan and Public Sector Consultants, the Children’s Healthcare Access Program – CHAP – is the only statewide program designed to increase access to a medical home for children in particular. It operates in several counties across the state.

The first CHAP began in Kent County in 2008, and today it is part of Health Net, which also treats adults. Officials say that children’s concerns can’t be treated in isolation from environmental challenges such as poverty and housing, which can play a large role in determining how healthy a child will be.

Maureen Kirkwood, executive director of Health Net, noted that more than 40 percent of children in Kent County are in Medicaid. The goal of the medical homes program, she said, is to ensure these kids “have one doctor, one provider, who coordinates all of their care.”

On the second floor of Health Net’s headquarters, a team of community health workers sits at work stations, navigating the bureaucracy for clients who are often battled by health-care bureaucracy.

Amelia Lopez, a veteran Health Net employee, hears from a doctor’s office that one of its patients has missed an appointment or has taken a child to the emergency room.

“I call the family,” she said. “I’ll say, ‘How’s your child? Did you call your medical home before you went to the ER?’

She helps the families overcome such common barriers as language, unreliable transportation and hours of operation for the doctors’ offices. If there is a lingering problem, Lopez, a community health worker, also makes house calls.

“We try to bridge the gap between medical care systems, primary care, hospitals, and the social services system,” she said.

A colleague, Elisa Perez-Arellano, who grew up in Mexico and has a master’s degree in social work from Grand Valley State University, handles complex referrals at Health Net, such as when clients need access to mental health care.

“Ninety-five percent of families don’t know what is out in the community,” she said. “There’s a lot of resources. I have to know them all to help them make the connection.”

Giving more kids a chance

The report from the Citizens Research Council and Public Sector Consultants says that if policymakers want to give more low-income children access to primary care doctors, the state might consider an estimated $10 million in funding that would allow CHAP to help local communities with telephone counseling, family education, asthma case management, transportation, and connections to community resources that are part of running a CHAP program.

Providing technical assistance to local communities to create their own CHAP programs would cost less than $1 million, the CRC-PSC study found.

Gina Schutter, manager of Medicaid products for Priority Health, a Grand Rapids-based health insurance company, said Health Net helps Priority ensure that families stay on track with important milestones such as well-child doctor visits during the baby’s first 15 months.

“We send quarterly reminders that they are due for a shot, that they are due for well child visits, Schutter said. “We send member incentives to get them in to get lead tests. There’s only so much we can do.”

She added: “Health care is not easy.”