By Dave Ranney
KHI News Service
Jennifer Gragg, right, washes dishes with her 13-year-old daughter, Kaylin, who”s battled chronic pancreantitis since she was 18 months old. Gragg, who lives in Ottawa, credits HealthWave, the state”s health insurance program for low-income families, and its case management services with saving her daughter”s life. (Photo courtesy Image Photo Bank)
OTTAWA, June 19 Kaylin Gragg celebrated her 13th birthday last week.
Her mother says the girl is lucky to be alive.
I just can”t say enough good things about HealthWave,” said Jennifer Gragg, referring to Kansas” health insurance program for children in low-income families.
Kaylin has chronic pancreantitis compounded by a rare condition “cystic fibrosis has manifested itself on her pancreas,” Gragg said.
The girl has been in and out of hospitals dozens of times.
“From Sept. 29 to today (June 13), she”s been in the hospital eight times, for three or four days at a time,” Gragg said.
“Anytime you put food in your mouth gum, candy, anything it stimulates your pancreas,” Gragg said. “If your enzymes are higher than they”re supposed to be and if your pancreas is already swollen, it causes pain. And I mean massive pain. These past few months, Kaylin was on a pain pump at home that was monitored three times a week by a home health nurse. I”m not talking like Tylenol I”m talking morphine, Phentanyl major pain medications.”
To circumvent her pancreas, Kaylin was, for several months, fed intravenously.
Gragg, 33, lives in Ottawa with her ex-husband, Curtis, their 8-year-old son, Wade, and Kaylin.
Until recently, the family was insured through Curtis Gragg”s long-time employer, an Olathe car dealer. But Curtis lost his job when the dealership downsized.
He now has a manufacturing job.
“When we had insurance, it didn”t pay for hardly anything,” Jennifer Gragg said. “And then, at his new job, they classified (Kaylin) as a “pre-existing condition” and came up with all kinds of things they wanted us to change doctors, they wanted to redo a lot of the testing we”d already put her through. We just couldn”t do that.”
That”s when Gragg heard about HealthWave.
“My husband”s always worked neither of us has sat around and lived off welfare,” Gragg said. “So I figured we weren”t eligible.”
But HealthWave covers families earning up to 200 percent of the federal poverty level $41,300 a year for a four-person household.
Together, the Graggs weren”t making anywhere near that.
“I feel like with HealthWave, Kaylin”s future is much brighter without it, I can”t say that she”d even be with us now,” Gragg said. “There are so many families out there that have children like Kaylin who can”t get insurance. HealthWave has been a godsend for us.”
Kaylin Gragg”s case is more grave and more expensive than that of most HealthWave clients and for those reasons the amount of personal attention the family receives from Children”s Mercy Family Health Partners, one of the two managed care companies under contract with the state to provide HealthWave services, also is atypical.
The other contractor is Unicare Health Plan of Kansas.
Both companies use enrollment and payment data to
detect cases with the most office visits, the most emergency room visits, and the highest pharmaceutical costs. Those then are targeted for intensive case management.
The Gragg family”s case met the criteria.
“We do it to see what we can do to make beneficiaries” lives easier and to look at costs,” said Taira Green, director of government relations and public affairs at Children”s Mercy. “But keep in mind, you may end up spending more on the front end
getting things stabilized
before you see a savings, but eventually there should be savings and an improvement in the beneficiary”s quality of life.”
Kaylin Gragg”s case is managed by Stevana McCullough of Children”s Mercy. She helped arrange for Kaylin to see a pancreatic specialist at Milwaukee Children”s Hospital.
“It was felt and the family agreed that (Kaylin) needed the benefit of a second opinion,” McCullough said.
McCullough pulled together the necessary medical records, got the trip to Milwaukee approved, and made arrangements for the family to stay at the Ronald McDonald House in Milwaukee. Children”s Mercy paid the family”s mileage.
“Stevana was awesome,” Gragg said. “She relieved such a burden. You have to understand: I”ve been through a divorce, I”m back with my ex-husband because we have nowhere else to go, I”m dealing with everything Kaylin”s going through and I”m trying to pay attention my 8-year-old son.”
By spending money, Children”s Mercy expects to save money.
“Some very good treatment options have come out of this,” said Ma’ata Touslee, director of health services at Children”s Mercy, referring to the Milwaukee trip. “We have hundreds of cases right now that are either in case management or are being evaluated for case management.”
Before the trip, Children”s Mercy paid a home health nurse to check on Kaylin three times a week. Kaylin, too, was on more than a dozen medications.
“We”re now down to one home-health visit a week,” Gragg said, “and she”s not taking anything. It may not stay that way, but it”s a start, it”s a reduction.”
Both UniCare and Children”s Mercy”s provide their case-managed clients pregnant women, especially with cell phones to ensure contact with a primary-care physician or nurse. The phones are programmed in a way that blocks personal calls.
Children”s Mercy and UniCare both have case-management offices in Topeka and Wichita. Headquartered in Kansas City, Mo., Children”s Mercy has 28 case managers, educators and outreach coordinators in Kansas. UniCare has 17 in Kansas and also uses workers in its offices in Indiana and Georgia.
UniCare has about 50,000 Kansas beneficiaries. Children”s Mercy has about 100,000. FirstGuard Health Plan of Kansas had the HealthWave contract before UniCare and Children”s Mercy won their respective bids. Records show FirstGuard was underbid by $15.6 million annually. The combined contracts, which took effect Jan. 1, are worth more than $250 million a year to the companies.
Among the case management services offered by Children”s Mercy and Unicare are those designed to help families cope with or fend off asthma, diabetes, and childhood obesity.
“We know that our population relies a lot on fast food,” said Linda Steinke, director of field operations for UniCare. “So we”ve created and we distribute informational
packets on how you can eat healthy at a fast-food restaurant.”
Instead of high-fat burgers, she said, beneficiaries are encouraged to have salads, lemon wedges instead of ranch dressing, water instead of soft drinks.
Similar initiatives are aimed at helping clients and their family members to quit smoking and educating pregnant women on the importance of prenatal care.
Both Stienke and Touslee declined to say how much money their respective case management programs have saved or how much their beneficiaries” health has improved.
Their programs, they said, are too new.
“We don”t have any Kansas data yet,” Touslee said, “but we”ve been very successful in Missouri.”
In 2005 and 2006, Children’s Mercy’s Missouri-based asthma management program reduced asthma-driven hospitalizations by 50 percent and asthma-driven emergency room visits by 40 percent. Total ER visits were reduced by 14 percent. Calls to a nurse-advice hotline increased 34 percent, according to Touslee.
When successful, case management keeps the companies” costs down allowing them to pass those savings to the state through lower contract bids.
But dollar savings aren”t the sole reward of effective case management.
Clients also can benefit.
“Case management services help people keep from spiraling into crises or if they do spiral, they get
help earlier. It”s a good application of services,” said Sky Westerlund, executive director of the Kansas Chapter of the National Association of Social Workers.
Jennifer Gragg
also has good things to say about case management.
“The thought of losing Kaylin tears me up inside,” she said, her voice choked with emotion.
“Without HealthWave, I”d don”t think we”d be where we are today. I don”t know if my daughter would be here today.”
Gragg signed a release, allowing Touslee and McCullough to discuss her daughter”s case. Otherwise, patient information is considered confidential.
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.