Program stresses childhood immunizations

Case managers educate publicly insured mothers

Before Trenton, NJ-based Horizon/Mercy started its Children’s Health Assessment, Maintenance, and Preventative Services (CHAMPS) program for publicly insured mothers with infants, many of the mothers didn’t realize the importance of getting immunizations and well-child visits for their children, says Giavanna Ernandes, RN, MSN, APNC, team leader for disease management, including the CHAMPS program.

"A big piece of our work is parent education. Many of the mothers didn’t understand that they had an insurance plan that would allow them to use a pediatrician. Once you teach people who are publicly insured how to access health care, they are so grateful and relieved," she says.

The health plan started the CHAMPS program on the heels of its successful Moms GEMS (Getting Early Maternity Services) prenatal program. (For details on the Moms GEMS program, see Case Management Advisor, July 2002, pp. 76-77.)

"We were doing so well and so proud of the GEMS program, but realized that after our postpartum call, there was no continuum. The mothers who were so well supported during their pregnancy lost their safety net," says Pamela Persichilli, RNC, director of clinical operations for Horizon/Mercy.

The Horizon-Mercy staff realized that the new mothers still needed support after their babies were born to ensure that the infants got the proper checkups and immunization.

The CHAMPS program begins when the babies are 1 month old and follows them through age 2.

Members of Horizon/Mercy have about 6,000 deliveries a year. CHAMPS enrolled 4,600 new babies in its first year. The plan’s HEDIS figures for well-child visits increased by 17% in the first year of the program.

When a woman goes through the Moms GEMS prenatal program and delivers a baby, her name is automatically sent to the CHAMPS department a month after delivery.

"We call the mother and begin the process of teaching them about the importance of immunizations, the various types of vaccinations their child needs, and when they need them," Ernandes says.

They match the mothers with pediatricians in their area, find out if there are barriers to getting the child to the physician, and arrange transportation if necessary.

"We ask about social and family issues and do whatever we can to help them," Ernandes says.

CHAMPS follows the Elk Grove, IL-based American Academy of Pediatrics’ (AAP) immunization schedule for newborns.

"We tell the mother that their baby needs immunizations at two months, at four months, and so on, and that we will call them to remind them and tell them what shots the baby will be getting," Ernandes reports.

Horizon/Mercy offers incentives to the mothers who take their babies to the physician.

Each provider has a supply of CHAMPS cards that include the baby’s name, birth date, and other demographic information, along with a
list of immunizations and well-baby visits. The physician circles what was done that day, signs the card, and mails it back to Horizon Mercy.

Mothers who follow the immunization schedule receive a gift package as an incentive.

For instance, when they go for the first series
of vaccinations at two months, they receive a gift packages with a baby bottle, bib, rattle, night light, and literature in English and Spanish about child safety from two to six months.

At six months, they receive a teddy bear, medicine cup, and more age-appropriate childhood safety information from the AAP.

The case managers work to build relationships with mothers who are in the CHAMPS program and to help them with whatever problems they are having. For instance, a CHAMPS case manager may help with an older child with asthma who is having problems getting to use his nebulizer in school.

"There are so many issues other than just the immunization. Our goal is to improve the experience they are having with the health care system. A lot of times when we help them with other social issues, we get more cooperation in getting the babies to the doctor for well visits. The case managers develop a trusting relationship with the members," Persichilli says.