STAR Kids – A comprehensive Managed Care Program for Pediatrics Patients with Chronic, Complex Health Conditions

Faculty

Needs Statement

Presentation Summary

Multiple stakeholder groups have advocated for a managed care solution for providing coordinated, quality care for children with disabilities over 3 prior legislative cycles (6 years); finally, STAR Kids legislation passed in 2013, and now 3 years later, it will be implemented. STAR Kids is a new Texas Medicaid managed care program that will provide comprehensive benefits starting November 1, 2016, to children and young adults ≤ 20 years with multiple diagnosis, high-needs healthcare needs and complex care management requirements. Enrollment is mandatory for those eligible. However, as STAR Kids implementation draws near, the increasing volume of concerns and complaints shared by patients and providers clearly indicates misunderstanding and confusion regarding the general intent of this “new” managed care program and the specific healthcare delivery processes designed to better serve this medically complex population. Addressing these inaccurate, basic knowledge assumptions prior to program start is key to ensuring program acceptance and preventing the loss, even if only temporary, of medically necessary services for this fragile patient population and avoiding resultant undesirable health consequences

Target Audience

This activity was planned to meet the educational needs of physicians, nurse practitioners, physician assistants, physical therapists, nurses, and social workers.

Objectives

• Discuss the purpose and general intent for implementation of a STAR Kids managed care Medicaid insurance program.
• Recognize the wide range of healthcare benefits offered by the STAR Kids program to enrolled, pediatric and adolescent patients with chronic, complex health conditions.
• Discuss the value of integrated care management to the health and overall wellness of the STAR Kids patient population.
• Describe the elements, generally, of a pod unit approach to integrated care management for a chronic, medically complex patient population.

Accreditation

CNE

UNT Health Science Center is approved by the California Board of Registered Nursing, Provider # 16274. This activity is approved for 1.20 Contact Hours.

TSBSWE

This activity is approved for a maximum of 1.00 Clock Hours for Social Workers.

Physicians

The University of North Texas Health Science Center is accredited by the American Osteopathic Association to award continuing medical education to physicians.

The University of North Texas Health Science Center has requested that the AOA Council on Continuing Medical Education approve this program for 1.00 hour of AOA Category 2A CME credits. Approval is currently pending.

The University of North Texas Health Science Center is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of North Texas Health Science Center designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The University of North Texas Health Science Center presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

ACGME Competencies

• Patient care
• Professionalism

IOM Competencies

• Provide patient-centered care

PT

UNT Health Science Center is accredited by Texas Physical Therapy Association, Provider 1810035TX. This activity is approved for 1.00 CCU for PTs and PTAs.

For successful completion, a participant must attend the program, complete the evaluation, and request credit online at conclusion of the activity.

The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE.

Faculty Disclosure

Neither Dr. Jose Gonzalez nor Dr. Kimberly Aaron have any affiliations with commercial interests to disclose. The UNTHSC Professional and Continuing Education staff and Grand Rounds Planning Committee have nothing to disclose.

Additional Information

Data collected as part of this activity may be analyzed as part of educational research to study the effectiveness of interventions. This project is included under UNTHSC IRB protocol #2017-056.