PP05 – Filling the Gaps: Interdisciplinary Care Coordination to Address Private Duty Nursing Downshifts in a Pediatric Medicaid Population
Highmark Health Options’ Private Duty Shift Nursing and Home Health Aide Program members make up one of our most complex member populations. Mostly medically fragile children and young adults with significant disabilities, they all have health needs that cannot be managed in the home environment without assistance from home care professionals as well as various other community resources. These members often have technology dependence and chronic health conditions that cause frequent hospitalizations. Some of the most prevalent conditions that our members experience include: cerebral palsy, respiratory disease, feeding disorders, seizures, cardiac disease, various congenital anomalies as well as significant developmental and behavioral diagnoses including severe autism. These members with special health care needs require specialized interventions to assure that their health and psychosocial needs are being met. They have been impacted by a nationwide nursing shortage which often leaves already fragile and stressed families without consistent and reliable home nursing and aide care. Highmark Health Options Care Coordination takes an interdisciplinary, collaborative team approach to interventions to address chronic nursing and aide downshifts as well as to address the health needs of our most fragile members. These complex members are assigned to both a nurse and a social worker within the health plan’s Private Duty Nursing team for comprehensive Care Coordination and Care Management. The members receive home visits at least twice per year in addition to frequent telephonic outreach. With input from all health plan participating private duty agencies, Highmark Health Options tracks downshifts per member monthly and addresses each case individually. The Care Coordination Department’s interdisciplinary collaboration as well as awareness of missed shifts and subsequent interventions reduces the instances of downshifts and increases positive member outcomes.