Medicaid spending for children with special health care needs is, on average, six times higher than spending for other children. Further, these children are at risk for preventable hospitalizations and costly emergency care resulting from poor coordination among families, medical care providers, schools, and other community-based programs. The pediatric community and state policymakers have looked to care coordination as a way to improve care and reduce costs for these children, but to date, there has been limited evidence about what works and under what circumstances.
A recent study in the American Journal of Managed Care by Mathematica health experts turned to research on care coordination for Medicare beneficiaries as a way to inform this issue. After identifying characteristics of successful care coordination programs tested on Medicare beneficiaries, the experts considered how these findings from the literature might be applicable to children with special health care needs in Medicaid. This assessment was based on their environmental scan of Medicaid financing and eligibility for care coordination as well as on roundtable discussions with key stakeholder and policy experts experienced in care coordination for children with special health care needs.
The study, funded by the Lucile Packard Foundation for Children's Health, determined a number of actionable recommendations that could apply to these children. Experts found six design elements that are consistently associated with improved outcomes from Medicare care coordination programs and relevant to children with special health care needs in Medicaid:
- Identifying and targeting high-risk patients (even among those with chronic conditions)
- Articulating clearly which outcomes programs are likely to improve
- Encouraging active engagement between care coordinators and primary care providers
- Requiring some in-person contact between care coordinators and patients
- Facilitating information sharing among providers
- Supplementing care coordinators’ expertise with that of other clinical experts
“Although there is no one-size-fits-all design for implementing a care coordination program for children with special health care needs, states and Medicaid managed care organizations have practical, evidence-based options for designing effective care coordination programs for these children,” said Kate Stewart, lead author of the study and senior researcher at Mathematica. “Their choices should account for the diversity of conditions and medical needs, familial capacity to coordinate care, locally available resources and funding, and social determinants of health among Medicaid-eligible children.”
“While health care for children with complex health conditions differs in many substantial ways from care for adults with such conditions, both share a need for care coordination,” said Edward Schor, MD, senior vice president at the Lucile Packard Foundation for Children's Health. “This study provides helpful guidance to state Medicaid programs, health plans, and others with responsibility for coordinating services for children and youth with chronic and complex needs.”
Read the authors' blog.
