Michigan-based Corewell Health Helen DeVos Children’s Hospital program has expanded and diversified the scope of its pediatric services during the last decade of operations. Delivering goal concordant care has been the largest strategic lever to its growth.
The health system provides pediatric palliative care, as well as primary, urgent and virtual care, behavioral health, cancer treatments and a range of other services. Helen DeVos Children’s Hospital program began in January 2015 and now features more than 70 health care specialty areas.
Among the significant pieces to the sustainability equation is offering a range of person-centered pediatric care services, according to Dr. Bradd Hemker, pediatric hospice and palliative care physician at Corewell Health. Hemker was among the clinicians who helped launch the health system’s pediatric palliative services. Communicating the value proposition of goal-concordant care has been the largest growth driver for the health system’s palliative pediatric program, he indicated.
“We are celebrating that 10-year mark now, and I had the honor of starting that program,” Hemker told Palliative Care News. “We’ve managed to sustain our program for this amount of time and grow, albeit slowly. At the heart of what we do are really two things: symptom management and support around decision making and helping families navigate difficult situations for their child who is facing a serious illness. We are a blank slate where families can sit and talk. We have the beauty of time as one of our currencies, sitting with families to have that conversation with many other parts of medicine as well.”
Corewell Health Children’s program includes two entities that form one network: Helen DeVos Children’s Hospital and Children’s in Southeast Michigan. Both entities operate multiple hospitals across Michigan.
The health system’s largest service line is its inpatient palliative care program, according to Hemker. Majority of the program’s patients are hospital-based referrals from across the health system’s neonatal, pediatric and cardiac intensive care units. The average inpatient pediatric palliative census is roughly 30 patients. Helen DeVos Children’s Hospital also operates an outpatient clinic to follow up with pediatric patients and families’ transitional care needs.
The hospital also has a fellowship program that trains hospice and palliative pediatric clinicians. The program has yielded roughly a dozen fellows in the last 10 years.
While the pediatric palliative care programs may not be a top revenue-generating business line, the value of these services has come in the form of improved clinical staff retention and family caregiver support, according to Hemker.
“When you look at revenue generation one of the biggest challenges is that we don’t make money, but we provide a remarkable service for patients and families on behalf of the hospitals,” Hemker said. “The buy-in from the institution is that this is important work that may come at a cost, but it leads to better care, better outcomes and better satisfaction. It support that teams like ours provide not only to patients and families, but also to other caregivers and providers. We talk a lot about provider burnout and wellness, and our team can help with that on some level. If we went away, I think that we would be noticed and missed.”
Pediatric palliative patients and families often navigate a fragmented health system and a complex web of community resources, according to Scott Hawkins, clinical program specialist at Helen DeVos Children’s Hospital. Seriously ill children sometimes see a range of health care specialists to address various physical, emotional and psychosocial needs. A strong suit for palliative providers is helping to ensure goal-concordant care delivery across the continuum, Hawkins said.
Having an interdisciplinary team trained in goals-of-care discussions is an important part of having a program that meets the varied needs of patients and their families, he stated.
“Care can be disjointed. It’s really trying to find out what is the most important thing right now,” Hawkins told Palliative Care News. “We want to know what the goals are for your child so that we can help drive the clinical course of managing it all with care that aligns seamlessly. We can have good, meaningful discussions about both of those things. We can lay it all out there and have discussions about the different information they’re getting from their specialists and put together the plan that works best for the child and family.”
A large future focal point for Helen DeVos Children’s Hospital will be increasing the ability to offer more home visits for palliative pediatric patients, according to Hemker. The health system currently partners with Hospice of Michigan’s Jo Elyn Nyman Anchors Programs for Children to provide the bulk of its home-based services for terminally ill patients and their families.
Finding a balance in clinical capacity will be pivotal to further expansion into the community-based pediatric palliative care landscape, Hemker said. Patient census volumes tend to be higher during certain periods of the year, with demand for pediatric care more substantial in winter months compared to others. The ebbs and flows of demand can create challenges in having sufficient clinical staff available to provide home-based care, he stated.
“An area that we hope to increase is what we do at home on the palliative end,” Hemker said. “Our palliative care work really focuses in the hospital first and foremost, as well as our clinic space and then the home visits come as possible. Part of it is flexibility. If providers aren’t there, that’s a bottleneck and an infrastructure problem. We need to have enough people available to see the outpatients and also respond when a crisis comes up in the hospital. We need that flexibility, which many parts of health care are not nimble enough to do yet.”
