MARY'S CENTER FOR MATERNAL CHILD CARE
Project Title: "Capital Clinical Integrated Network (CCIN)"
Geographic Reach: District of Columbia
Funding Amount: $14,991,005
Estimated 3-Year Savings: $17,712,000
Mary's Center for Maternal Child Care in Washington, D.C. received an award to implement and test an integrated clinical network to improve care for high-utilizing chronically ill Medicaid recipients in the D.C. area, including those who rely on emergency room visits for primary health care. The project will use care teams and telemedicine to communicate with these patients, develop care plans for them, and personally manage their care as they are gradually transitioned into patient-centered medical homes. The result will be lower cost from reduced dependence on crisis care and ER visits and better health care for people with controllable chronic conditions such as diabetes, hypertension, asthma, and co-occurring mental illness. Over a three-year period, Mary's Center for Maternal Child Care will hire and train 42 health care workers to serve as care managers and community-based care coordinators.