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Overview

PICs Coverage AreaIn a time when public officials and health care agencies are focused on reducing costs while maintaining quality care, the Pediatric Integrated Care System (Ped-I-Care) has emerged as a leader within the industry. As a program which administers benefits for CMS Plan, Ped-I-Care has realized measurable success across all areas for which it is responsible: fiscal responsibility, high quality care, and documented provider and member satisfaction.

Since November 2003, the program has helped thousands of children from families with a low income receive the special health care they need and deserve. The program has grown by leaps and bounds, and now serves 51 of Florida’s 67 counties. Remarkably, cost reductions to the state for Ped-I-Care’s Title 21 program is conservatively estimated at $61 million over the course of the last decade. For Title 19 (Medicaid), the cost savings are estimated at more than $12 million since 2007. The children who are served by this program, along with their families and their providers, are extremely satisfied with their participation and as a result, the program has been able to responsibly expand and realize continued success. The levels of success, in fact, have continually improved with every audit, survey, and research project that is conducted.

Ped-I-Care’s Quality and Utilization Management programs are the backbone and core of its continuum of care, with physicians making decisions on requested services. Physicians, in fact, are the only ones who may reduce or deny services members receive. Because of the design and consistency of this core concept, Ped-I-Care has achieved perhaps the most elusive of all health care goals: efficiently meeting the needs of its beneficiaries while saving money.

In essence, the program has broad-spectrum effects upon the health of Florida’s economy because of caring for its most vulnerable children. Members are receiving necessary care they might otherwise go without, and Florida’s taxpayers realize the benefit of matching federal funds. The hidden costs of health care for the uninsured are also reduced, as Ped-I-Care members are not forced to choose between seeing a doctor at the time that it’s needed or waiting until routine problems become real emergencies. Ped-I-Care offers the best of both worlds, for elected officials and health care executives whose attention is focused on budgetary reductions and the needs of their constituents. It serves as a model for the state of Florida, and, ostensibly, the rest of the nation.