Oct
25
2016

STAR Kids to bridge gap for thousands of children with complex medical needs

102716starkidsinside350Three years ago, Jessica Coker of Willis, Texas, gave birth to her son, Christopher. Unbeknownst to Coker during her pregnancy, Christopher would be born with various medical issues. Christopher has apert (a cranio facial syndrome) and a heart murmur. He also relies on a trach and has, at times, needed a feeding tube.

After delivering her baby, the new mom was suddenly faced with needing to learn how to care for a child who would have very complex needs, as well as how to manage the comprehensive care he would need from more than two dozen specialists. Just in his first week of life, Christopher had 17 doctor’s appointments. As a newborn, Christopher was transferred to Texas Children’s and had a team of doctors here taking care of him, successfully treating some of his issues and managing others.

Today, the toddler still sees about 24 doctors at Texas Children’s and other medical facilities near his family’s home in Willis. He’s doing well, because he is receiving excellent care – and because his mother has created a system to manage and coordinate his complex care.

“We currently have great access to care,” Coker said. “I can call doctors directly, and they do a fantastic job when I need them the most. It’s a team approach that we’ve worked hard to establish.”

Coker’s fortunate to have figured out a system to manage her son’s care. Learning to advocate for and manage the care of children with complex medical needs is often critical to their ability to thrive and realize a decent quality of life. Beginning November 1, STAR Kids will provide the support these families need, and Texas Children’s Health Plan is leading the way. Last year, the Health Plan was selected by the Texas Health and Human Services Commission as one of three managed care organizations offering the STAR Kids plan in Harris, Jefferson and Northeast service areas.

“The STAR Kids contract allows the Health Plan to increase its reach to about 40,000 new children and teens in 54 counties,” said Texas Children’s President and CEO Mark Wallace. “These children see multiple specialists and therapists, and many receive home care services. They typically see at least one physician every week.

“Coordination and management of care is essential for these children. It helps prevent children with significant intellectual development disabilities or complex medical problems from falling through the gaps and provides a structure where their progress can be followed throughout the system.”

While many of the children transitioning into STAR Kids already are Texas Children’s patients, we expect thousands more to become part of the Texas Children’s system through enrollment in STAR Kids. In preparation for this patient volume, the Health Plan has already hired nearly 300 care coordinators.

“It is the strong partnership between the care coordinators and the families that will make this feel different even for the families already in the system,” said Texas Children’s Vice President Diane Scardino. “These care coordinators are registered nurses and certified social workers who will bring much needed support to families who are managing care for their children in what can sometimes be an incredibly complex system.

“They will visit with families, assess their children’s needs and develop care plans to address those needs. Texas Children’s will provide the resources around care coordination and home based services, creating a much more robust system of care for them.”

STAR Kids’ new care model is a huge step in supporting the unique needs of patients and their families, and improving their access to health care services, while also reducing preventable events or unnecessary visits to the hospital or care provider. There are about 180,000 children across Texas eligible for the STAR Kids program, with about 40,000 expected to be enrolled in Texas Children’s Health Plan.

“Texas Children’s is proud to be a part of this program that will mean so much to help so many families throughout Texas,” Wallace said. “This program and the work we will do to help ensure these families’ needs are met and that their children receive the best possible care speaks to our mission. This is what Texas Children’s has always done.”

Information about STAR Kids

FAQs about STAR Kids and Texas Children’s involvement
STAR Kids information on Texas Children’s Health Plan website
Texas Health and Human Services website