Identifying Wraparound Services For Complex Care

Understanding experiences, identifying service gaps, and exploring opportunity spaces for low-income families with a medically complex child. 

Design Challenge

In 2015, the Health & Human Service Commission awarded a Medicaid contract to Children’s Health in Dallas for the STAR Kids Program, a health plan catered to a population of vulnerable families with a medically complex child. 

Starting in 2016, STAR Kids will be the first Medicaid managed care program specifically serving families with children using disability-related Medicaid. In this expansion of Medicaid managed care, Children’s is asked to address the customized needs of these families as they relate to coordination of care, health outcomes, access, cost, administrative complexity, preventable events, and long-term services. 

Approach

To address the unique needs of these families, Children’s partnered with BIF to better understand service gaps and experiences of similar families at Children’s Complex Care Clinic. This clinic is dedicated to caring for families who have a child, primarily on Medicaid, with complex diagnoses such as chronic lung disease, rare genetic disorders, congenital heart disease, and behavioral or neurological disorders. 

The clinic recruited representative families and BIF conducted semi-structured contextual interviews and generative research in 17 families’ homes—4 of which were Spanish-speaking only.

Impact Statement

Following home interviews, BIF analyzed findings and developed a comprehensive collection of experiences, gaps, and actionable opportunity spaces for Children’s to develop wraparound services for the STAR Kids Program.

BIF encouraged an evolved definition of the patient to include the entire family, with a particular focus on the primary caregiver—Mom. Prioritized opportunity spaces assess, relieve, support, and develop Mom as the essential partner in providing the quality care that a medically complex child requires.