Cook Children's Health Plan (CCHP)

Cook Children's Health Plan (CCHP) Cook Children's Health Plan (CCHP) provides health care coverage to a vulnerable population that may not otherwise be able to access or afford care-low-income families who qualify for government-sponsored programs such as Medicaid and the Children's Health Insurance Program (CHIP). Members enrolled in CCHP are assured timely access to necessary medical care, including preventive services such as well-child visits, immunizations and prenatal/postpartum care. Cook Children's Health Plan's role is to manage and, in conjunction with Cook Children's and other network providers, deliver care to its members. Since it was established in 1999, the organization has successfully grown to a substantial operation, currently covering more than 140,000 members, primarily representing children and expectant mothers. In addition to the nearly 2,900 providers in the Cook Children's Physician Network, members have access to approximately 1,400 additional primary care physicians, 240 OB-Gyns, 2,300 specialists, 680 behavioral health providers, and numerous hospitals, surgery centers and a variety of urgent care and clinic locations. This comprehensive network ensures access to quality health care providers for all CCHP members. Members with chronic conditions such as asthma and diabetes can participate in the plan's vigorous and effective disease management programs, which help prevent unnecessary and costly emergency department visits and hospitalizations, as well as help prevent further deterioration of members' health. Although Cook Children's Medical Center does not provide maternity services, pregnant members are closely cared for and monitored to avoid complications and premature deliveries. Cook Children's Medical Center is often the hospital of choice for members' newborns who require neonatal intensive care. Medicaid Renewal Much of CCHP's focus for 2023 centered around preparing for and responding to the Request For Proposals (RFP) to win renewal of its Medicaid contract with the State of Texas. Completing and submitting the application is a long and arduous process. The Health Plan submitted its completed application in February and made its oral presentation in October. It will be another year before CCPN is notified of renewal. Effective Health Management In response to a growing community need for behavioral health care and case management, CCHP brought this previously outsourced service in-house in 2022. Provider contracting, utilization management, care management and claims payment are now managed by an in-house Behavioral Health Director and behavioral health trained staff. In FY23, CCHP marked the first full year of managing this service, which has led to improved case management and care coordination for the health of the whole person - mind, body and spirit. Collaboration and Prevention Collaboration with providers and community based organizations is key to CCHP's success in helping members achieve optimal health. The Health Plan actively collaborates with therapy providers, private duty nursing agencies, pharmacies, home health agencies and other community resources to enhance the quality of care provided. In 2023, CCHP created its first Community Advisory Committee, formalizing and expanding partnerships with several community-based organizations. This group was particularly active during the "unwinding" of the COVID Public Health Emergency when it came to an end. They were instrumental in getting the word out to Medicaid families about the potential loss of coverage if they did not take the required action when the State began re-certifying members. The Health Plan is actively working to address food insecurity among its members. In 2023, as a value-added service for members, pregnant women whose care is coordinated by CCHP case management, gained access to the health food delivery service Tangelo. These members can get up to five monthly boxes of prepared food or groceries delivered directly to their door by Tangelo. In 2023, CCHP and ACCLAIM, the physician group that staffs JPS, outlined a formal collaboration agreement to enhance the quality and safety of prenatal and postpartum services received by patients of ACCLAIM, particularly CCHP members of color. When ACCLAIM identifies a pregnant CCHP member under the care of one of its physicians who would benefit from additional support, ACCLAIM notifies CCHP so that it can coordinate additional care and resources during pregnancy and after delivery. Transformative Partnership In April 2023, Cook Children's announced a first-of-its-kind partnership with JPS Health Network, the City of Fort Worth and local non-profit organizations to bring critical health care and social services to the traditionally underserved children and families living in Fort Worth's Las Vegas Trail (LVT) area. The future Las Vegas Trail Neighborhood Health Center, located on 3.7 donated acres of land, will be home to various pediatric and adult medical and social services as well as a Fort Worth Police storefront. The two-story, 40,000-square-foot center will open in late 2025. The addition is another step in the vision of city leaders, local nonprofits and health care partners to transform Fort Worth's struggling LVT neighborhood into a safe, healthy community with vital resources that support residents' ability to live, work and play. Approximately 7,500 CCHP members live in the LVT area, making CCHP a key player in service delivery and care coordination at the center. When complete, CCHP staff will be embedded at the center to help members navigate resources, be they offered there or by another provider. For example, for those without internet service that need to attend a telehealth appointment, there will be private space within the center equipped with internet and video where community members can access this service with the help of an on-site CCHP representative. WestAid Food Bank will relocate to the LVT Neighborhood Health Center. In lock-step with this resource and its mission to fight food insecurity, CCHP will provide an on-site nutritionist to help community members gain access to nutritious food and learn how to prepare healthy meals even if their living space does not have a full kitchen. The Health Plan will support plans to offer a workforce training program at the center where residents can learn customer service, phone management and general office skills, to name a few. This job training initiative will give LVT residents employable skills to gain stable, well-paying jobs within the health industry while also building a new pool of qualified candidates for filling staffing needs at Cook Children's and JPS. Working directly with providers from JPS, CCHP will also support the care of pregnant women with parenting classes, maternity support groups and classes for women preparing for childbirth. All of these collaborations and value-added resources provided by CCHP help improve the health and well-being of their members.