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Steering families through the health-care maze, a cadre of case managers transcends traditional medical care for low-income families


Priority Partners’ Kathy Just and patient Ashley Asilis outside Ashley’s Silver Spring home.

On any given day, Ashley Asilis’ entourage numbers about 25. No, she’s not a movie star, though her striking features could open doors in Hollywood. Rather, that’s how many people it takes to keep the 5-year-old healthy.

Ashley was born with a metabolic disorder that causes seizures. By the time she was a year old, her weight had plummeted off the growth charts, and despite being on medication, she had daily seizures.

Ashley was referred to Priority Partners, the managed care organization owned by Johns Hopkins HealthCare and Maryland Community Health System, a group of eight federally qualified health centers. Priority Partners is one of seven MCOs authorized by the state to provide health care services for low-income families on Medicaid or the Maryland Children’s Health Insurance Program.

Marking its 10th anniversary this month, Priority Partners serves some 113,000 members—nearly a quarter of the state’s Medicaid population—in every Maryland county, from the asthmatic child in Caroline County to the heart transplant recipient in East Baltimore. Its specialized disease management programs focus on conditions as diverse as HIV, renal disease and pregnancy.

The group’s case managers jump through hoops to make sure clients are satisfied. “We take the whole person into account and try to be the link to every imaginable service,” says Michelle Hawkins, director of case management.

Consider Ashley’s case.

Ashley is enrolled in the Children with Special Needs program. Nurse case manager Kathy Just first met Ashley three years ago in the cramped Silver Spring apartment she shares with her parents and two older sisters. Ashley was receiving a tube feeding to supplement her mother’s milk. An interpreter was on hand to make sure everything was translated into Spanish, the family’s first language.

Ashley had been receiving physical and speech therapy and vision care four times a month for severe developmental delays, but her seizures were worsening. After consulting with Ashley’s primary care doctor, Just devised a comprehensive care strategy. Working with him throughout, Just arranged for Ashley to see Hopkins physicians and a dietitian in East Baltimore. They put Ashley on a high-fat diet proven effective in reducing seizures.

From the outset, Just has coordinated practically everything—from specialists’ consults, to durable medical supplies, to therapy. She even meets with teachers when necessary. She helps the family with follow-up appointments, medication adherence and questions about Ashley’s health care needs. And Ashley is but one of the nurse manager’s 60 cases.


From left, Vicki Fretwell, Sue Phelps and Michelle Hawkins outside their Glen Burnie office.

Priority Partners opened in 1997 with 6,000 enrollees and a staff of four nurses. “It was all very new back then,” says Sue Phelps, the senior director for administration who launched the program. “We had a big learning curve. There were lots of hiccups along the way.”

The MCO recorded $55 million in losses over eight years. In 2004, former Anne Arundel County Executive Bobby Neall became the program’s CEO. He and his staff renegotiated contracts with certain providers to lower their payment rates and found less expensive lab and radiology sites. Neall expects a $28 million profit in the fiscal year that ended June 30.

Today, Priority Partners is Maryland’s second oldest MCO. Its administrative staff has grown from 10 to 22; its case management team, from three to about 50.

Key to Priority Partners’ success is a statewide network of more than 9,000 physicians who welcome the MCO’s members into their practices daily, says Vicki Fretwell, director of external affairs. “We’re homegrown. We build relationships with people, and we do serious research.”

Indeed, of the 15 organizations selected from a nationwide pool of applicants, Priority Partners is the only one in Maryland awarded a grant to look at ways to better coordinate services for foster care children and chart new techniques and best practices.

At the core of Priority Partners’ success, though, is vigilant casework. The rewards are sweet. Ashley, for example, has gained weight, is almost seizure free and has started to babble. “Her parents were once too overwhelmed to call me if they had a problem,” says Just. “Now they realize I’m one of her biggest advocates.”

Judy Minkove

Open Enrollment 2007

Quick Read

Priority Partners is a joint venture between Johns Hopkins HealthCare and Maryland Community Health System, a group of eight federally qualified health centers.

One of Maryland’s seven managed care organizations, it provides health care services for low-income families.

Its staff of 50 nurse case managers work in every Maryland county.

Priority Partners’ care-management programs focus on conditions like renal disease and HIV.

 

 

Johns Hopkins Medicine

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