The Indiana Complex Care Coordination Collaborative (IC4) is an innovative program made possible in cooperation with Indiana Family and Social Services Administration and funded via Section 9817 of the American Rescue Plan Act as a Home and Community Based Services (HCBS) Stabilization Grant.
IC4 delivers a virtual coaching program for primary care teams and embedded nurse care coordinators to improve care for targeted populations of patients who are at particular risk for care disparities and unmet needs. With expansion dollars, the project is building across the state to include both populations of children with medical complexity and adults with intellectual or developmental disabilities.
The model was initially piloted in three pediatric practices to serve children with medical complexity from 2019 to 2022 as part of a 10 state HRSA-funded Collaborative Improvement and Innovation Network (CoIIN) to Advance Care for Children with Medical Complexity. The COIIN for CMC established three goals, to improve:
- Quality of life for children with medically complex conditions
- Well-being of their families
- Cost effectiveness of their care
The initial participating pediatric practices serve families living in rural, mixed and urban settings:
- Witham Pediatrics in Lebanon/Zionsville/Crawfordsville
- ALL IN Pediatrics in New Albany/Salem
- IUH Riley Pediatric Care Center in Indianapolis.
Each practice hired a nurse care coordinator to focus their full-time services on meeting the needs of 100 children with complex health conditions and their families. Family satisfaction surveys measure quality of life and well-being. Primary care team surveys measure wellness, teamwork and burden of care delivery. Successful responses from families and primary care teams prompted further expansion. It is the program’s aim to demonstrate scalability and sustainability for future application as an ongoing Indiana Medicaid program for complex care coordination.
