As a MiPCT Pediatric Care Manager for the Children’s Medical Group in Bay City and Saginaw, I see children who are struggling with all kinds of chronic conditions, like diabetes, ADHD and anything in-between. Care managers like myself work with children’s primary care physicians, their families and even their schools to create custom treatment plans, ensuring they can lead full lives no matter what they’re going through. What’s MiPCT? It stands for the Michigan Primary Care Transformation Project. The goal of MiPCT is to figure out ways to be proactive about cutting health care costs, and one way that’s done is by helping patients manage chronic conditions better. That’s the work I do every day. My focus is with pediatric patients, which includes infants up to 18-year-olds, and their parents. A large part of my job is creating treatment plans, collaborating with other physicians and preventing readmissions to hospitals, meaning I follow up with all of my patients after they have a hospital visit. I’ve dealt with thousands of patients throughout my career, but one I met over a year ago stands out. Bailey had always been energetic and on the go, but as she got older and entered school, she began having behavioral difficulties at home. Her parents noticed that she needed much more direction than her siblings, struggling to carry out simple tasks or establish a daily routine. Concerned about her, Bailey’s parents took her to see their pediatrician, who referred Bailey to me. I met with her for a first visit and noted a few things: she didn’t like transitions at all and didn’t speak very much during our meeting (her parents mentioned she used to speak a lot more when she was younger). In order to fully track and find patterns with her symptoms, I reached out to her teacher. Together, we dismissed the possibility of the problem strictly being ADHD and analyzed her development issues such as her inability to focus, have routines or adjust to changes. Using an AQ10 test, we diagnosed Bailey with autism. From there, it was an “all hands on deck” approach. In addition to teaming up with her teacher, we worked with Bailey’s siblings to teach conflict resolution techniques. We also referred Bailey to a psychiatrist and a certified autism specialist. Because MiPCT is focused on managing chronic conditions correctly, Bailey’s therapist meets with her at home – in her natural environment – and works with the whole family, something that’s been tremendously helpful as everyone adjusts to her diagnosis. Even though I see a lot of children, this case stands out to me. I was able to see firsthand the direct effect of a policy change - Blue Cross had adjusted their criteria in terms of access to autism services. Families who are dealing with this diagnosis are now able to obtain care earlier. As a health professional, I no longer have to wait in line to get approval to treat a patient. Starting treatments as soon as possible is crucial, I’m excited that insurers like Blue Cross are making that easier. My work with children like Bailey doesn’t just end at diagnosis. Collaborative care is tremendously valuable, and because of Blue Cross’ support of the MiPCT program, Bailey had all of her team members at the same table asking what is in the best interest of Bailey. We worked to establish how she could succeed not only at home, but at school and in her medical environment as well. A year into her diagnosis, Bailey is doing quite well. She still struggles at times, but working with an autism therapy plan and having a streamlined approach to her care has put her on the right path. This post is part of a storytelling series we call, “Beyond the Card.” These stories will feature Blue Cross Blue Shield of Michigan members, employees, and communities who are making meaningful differences throughout our state. We invite you to follow Beyond the Card stories here at MIBluesPerspectives.com and through the hashtag, #BeyondtheCard on our social channels. If you have a story you would like to share, please feel free to contact us at stories@bcbsm.com. Photo Credit: Jake Guild
