On-Call Resource for Medically Fragile Kids Improves Care, Saves $116M

There’s a point at which gaps in health care can become gaping holes for parents of children with specialized medical needs.

For Carla Thorne, that point came after a series of unsuccessful trips to a local urgent care clinic with her adoptive son Reese. Born prematurely at 24 weeks with cerebral palsy and underdeveloped lungs, Reese is susceptible to respiratory infections that can make it hard for him to get enough oxygen. “But when we’d show up at urgent care they’d see his ‘trach’ and say, ‘Oh no, we don’t do that here,’” says Thorne. So, the family would head to the ER where inevitably Reese would be hospitalized for problems that, with proper prevention and the right tools, might have been avoided or easily treated at home.

It’s not that family physicians, who might see one or two cases like Reese in a career, lack skill or compassion to care for these kids. And it’s not the fault of the emergency department staff who out of an abundance of caution end up hospitalizing these children. “It’s an organizational failure, a breakdown in the system, and an expensive and inefficient way to support these children and their families,” says University of Utah pediatrics professor Nancy Murphy, M.D., who as a rehabilitation specialist at Primary Children’s Hospital, treats hundreds of so-called “medically fragile” children a year. In 2007, she resolved to find a better way.

Her solution: a consultative medical home, or “Comprehensive Care Clinic” for the highest-cost, most medically complicated patients at Primary Children’s Hospital. Functioning as an on-call resource for families and their pediatricians, the clinic has exceeded all hopes, contributing to a sharp reduction in emergency room admissions, hospital stays and medical costs for nearly 600 kids—a total of $116 million from January 2008 to July 2014.