Children�s Healthcare Access Program (CHAP)

Michigan Nightlight: In your view, what makes your program innovative, effective or remarkable? 
Rebekah Fennell, Executive Director of First Steps: The Children’s Healthcare Access Program (CHAP) is based on the simple premise that vulnerable children deserve to be as healthy as other children and that all of us benefit when health disparities are eliminated. CHAP is remarkable in that it improves the health of children on Medicaid and the quality of care they receive, while also reducing the cost of delivering health care. It really proves the value of prevention. CHAP is all about getting children high quality preventive care in a family-centered medical home. That keeps them out of the emergency department and the hospital where treatment is much more expensive.
 
What was the best lesson learned in the past year?
The best lesson learned is that CHAP works! Among children with the most significant needs, emergency department visits dropped 35 percent and inpatient hospital admissions dropped 62 percent. An independent cost benefit analysis found that the immediate social benefits exceed the costs by one-fifth – a return of $1.20 for every $1 invested. That is a conservative analysis and can be expected to increase over time since the benefits of good health in childhood are compounded as people age. 
 
Based on the success of the project in Kent County, CHAP is being implemented in other communities across Michigan. Wayne County CHAP launched last year, and about a half dozen other communities are in various stages of developing and implementing the CHAP model.
 
What was the hardest lesson learned in the past year?
The hardest lesson that we’re learning – and our biggest challenge moving forward – is about the complexity of sustaining CHAP. Its long-term sustainability likely will require that it be incorporated into the day-to-day workings of the healthcare system. What we know is that vulnerable children and their families need the assistance that CHAP provides – and that, in the end, it saves healthcare dollars.

We simply need to continue to make the case that healthier children and higher quality healthcare are worth the up-front investment… because the pay-off down the road is huge.

 We simply need to continue to make the case that healthier children and higher quality healthcare are worth the up-front investment… because the pay-off down the road is huge. 
 
What really differentiates this program?
CHAP is focused on kids. All over the country, there is a big emphasis on the patient-centered medical home – an approach to providing comprehensive, coordinated primary care. But almost all of the effort is geared toward adults.  CHAP is one of the nation’s few pediatric medical home projects. 
 
It is critical that our society invest in improving children’s health. As mentioned earlier, the benefits of good health are compounded throughout life. The investments we make in young children will continue to pay dividends as those children age.
 
What are the keys to success for your program?
Collaboration is crucial to the success of CHAP. CHAP is much more than a program or service – it’s a new approach to pediatric care that brings together all aspects of the healthcare system to coordinate our efforts and ensure that we’re doing all we can to improve children’s health and make the best use of limited resources.
 
It is key that physicians are heavily involved in the leadership of CHAP. 

Traditionally, many social programs have worked outside of primary care, creating separate silos. Part of what has made CHAP so effective is that pediatric practices and clinics are central to the model. 

Traditionally, many social programs have worked outside of primary care, creating separate silos. Part of what has made CHAP so effective is that pediatric practices and clinics are central to the model.
 
How do race or diversity affect the work of your program?
Approximately 40 percent of Kent County children are covered by Medicaid, a number that has grown from 27 percent in 2004. Children of color make up a disproportionate share of the population enrolled in Medicaid. We have been intentional about assembling a staff that is representative of the families we serve, including bilingual staff members. 
 
Research shows that children with Medicaid have poorer health outcomes and are more likely to be hospitalized than children with private insurance. CHAP is working to reduce those disparities by removing the barriers that keep vulnerable children from high quality primary care. These barriers include lack of information about preventive health care, lack of transportation, language and time constraints.