Miller School Awarded $4M to Expand School Clinics and Create National Model

The Miller School, in partnership with a handful of diverse and novel collaborators, has received a highly competitive $4 million federal Health Care Innovation Award to expand the services that 12,000 Miami-Dade County public school students receive through their school-based clinics – and save Medicaid far more than the grant investment.

One of only 107 awarded nationwide by the Centers for Medicaid and Medicare Services’ new Center for Innovation, the three-year grant will sustain the primary care program and add dental and mental health services to those already offered at nine school clinics originally funded by the Dr. John T. Macdonald Foundation and staffed by the Miller School in four elementaries, two middle schools and three high schools in North Miami, North Miami Beach and Overtown. The grant program also will extend services to the students’ families.

Established by the Affordable Care Act to find new ways to improve health care while lowering costs and creating jobs, the Center for Innovation received nearly 3,000 applications for its first innovation awards, and funded only one proposal exclusive to Florida and only one school-based program in the nation – the Dr. John T. Macdonald Foundation School Health Initiative at the University of Miami.

“Chance favors the well-prepared, and we were ready,” said Arthur Fournier, M.D., professor of family medicine and community health and associate dean for community health affairs, who spearheaded the school-based clinics with the Macdonald Foundation a dozen years ago. “We can attribute our success in this highly competitive process to the wonderful infrastructure created with the support of the Dr. John T. Macdonald Foundation, the Batchelor Foundation, and The Children’s Trust, which the citizens of Miami-Dade County generously support through their tax dollars.”

The School Health Initiative’s medical director, Joycelyn Lawrence, M.D., assistant professor of family medicine and community health, said the grant will enable the clinics to meet their goal of delivering care with a holistic approach. “Our students and their families now have access to a host of services at their fingertips,” she said. “School health programs are increasingly being recognized as a viable alternative for health care. This grant will allow us to demonstrate this. We may serve as a child’s medical home or collaborate with a child’s primary care provider when needed.”

Miller School Dean Pascal J. Goldschmidt, M.D., called the award “wonderful” for supporting such a stellar school health program. “It is all about kids and doing the right thing for kids’ health,” the Dean said. “We are proud of Drs. Joycelyn Lawrence and Art Fournier and their team for the great opportunity that they bring to the children of Miami-Dade County.”

Partnering with the University of Florida College of Dentistry, which operates a dental clinic in Hialeah, the Miami-Dade Area Health Education Center, and mental health services, the Miller School will oversee the training of dental hygienists, physicians and nurse practitioners who will provide preventive oral and mental health services via the telehealth system already in place in the school clinics.

For the past two years, Lawrence and her team have been using the high-definition video conferencing system to see students who complain of sore throats, rashes and other ills at any one of the nine schools while they are physically located at another, or to refer children for video consults to specialists on the Miller School campus.

“What we’re doing with the grant is building economies of scale on top of our existing infrastructure,” Fournier said. “The dental hygienists will be conducting oral health exams and mental health providers will be able to interview people via the cameras we already have in school. It’s simple but elegant.”

By partnering with the Center for Haitian Studies, the site of another primary care clinic Fournier helped establish, the Miller School will help ensure eligible children are enrolled in Florida’s new Medicaid HMOs and receiving covered services. Located in Miami’s Little Haiti neighborhood, the Center for Haitian Studies will deploy what Fournier calls a “small army of culturally and linguistically competent community health workers” to serve as peer educators who can explain to parents the importance of enrolling their children and taking advantage of the services offered at their child’s school clinic. Community health workers also will refer parents in need of care to the center clinic.

Over the three years of the grant, Fournier estimates that Medicaid will save $5.6 million, largely by improving health, managing chronic illness, and reducing emergency visits to UM/Jackson Memorial Hospital. The grant is also expected to create 25 new jobs.

Kim Greene, executive director of the Dr. John T. Macdonald Foundation, which has contributed more than $9 million to the School Health Initiative since its inception in 2000, said the innovation award will help the foundation fulfill its dream of creating a self-sustaining program that can serve as a model for the nation.

“Not only will it expand critically needed health and mental health services to children in a school setting, giving them a better chance to do well in school, but also of great importance, it will help students and their families get on Medicaid, remain in the health care system, and stay healthy,” Greene said. “It also gives UM the opportunity to bill for those services and create a funding stream that will ensure the programs’ sustainability. That has always been our dream. We set out to launch a one-of-a-kind model for the nation, and then bring in dollars that would allow it to continue without depending largely on our support. With the help of UM, the Batchelor Foundation and The Children’s Trust, we have created that model by building novel partnerships between dentists, mental health workers, community health centers and schools.”

Fournier summarizes the innovation another way: “In designing the clinics, we thought about what would be best for kids and parents, not what would be best for providers and/or the insurance companies, but what we ended up with was a better system for everyone.”

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