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Complex Care Coordination

Together, Montana Pediatrics is working to provide realistic solutions for families and medical providers to improve the care delivery for children in Montana with medical complexity.


Given the rural landscape of Montana, we recognize the challenges that patients, families, and healthcare providers encounter in providing integrated, coordinated medical care for children with medical complexity. Care coordination is essential to improving the lives of our families and children in Montana and is meant to be a proactive, family-centered service with the goals to:

  • minimize adverse medical outcomes;
  • maximize health for the patient;
  • improve quality of life for the family; and
  • improve healthcare resource allocation and utilization.

The Montana AAP State Child Health Policy Agenda has identified the need for all children in Montana to have access to high-quality healthcare delivered in a comprehensive, family-centered medical home, however, according to the most recent statistics, only 51.9% of children in Montana have a true medical home.

We are excited to be a part of the inaugural Montana cohort of the Boston Children’s Care Coordination Academy which is bringing together talent across the state to identify how to improve care coordination and management for those with medical complexity or special health care needs.

Our goal is to put families at the center of their care coordination, building a “medical neighborhood” that links local, regional, and even out-of-state healthcare together to ensure flawless information transfer between care teams. Together, we can remove the burden of care coordination and navigation from caregivers back to the medical teams. We embrace the concept that “a medical home is not a building or place; it extends beyond the walls of a clinical practice. A medical home builds partnerships with clinical specialists, families, and community resources.”

 

Pediatric Type 1 Diabetes Care Coordination


There are an estimated 500 children in Montana with Type 1 Diabetes (T1D), a chronic condition that is time and resource-intensive for families, schools, and communities and requires subspecialist expertise. In partnership with the Leona M. and Harry B. Helmsley Charitable Trust, we are working with families and providers across the state to build a model to improve access to care, quality of services, the cost of care, and rural provider experience.

 

To learn more about our work with Montana’s pediatric T1D community, click here.

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