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Report Details Safety Net Health Plan Efforts to Care for Children with Special Health Care Needs
FOR IMMEDIATE RELEASE: February 6, 2017
FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515, jvanness@communityplans.net
NEW REPORT DETAILS SAFETY NET HEALTH PLAN EFFORTS TO CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
WASHINGTON – A new report issued by the Association for Community Affiliated Plans (ACAP) examines the efforts of Safety Net Health Plans to deliver coordinated care for children with special health care needs (CSHCN). The report was prepared by NORC at the University of Chicago.
Children with special health care needs have—or are at risk for having—chronic conditions which often require services from across the health care spectrum, including specialists and people who provide other social services. More than 1 in 7 children in the U.S. meet the criteria for having special health care needs. It is widely recognized that such children benefit from heightened care coordination and care management services.
Medicaid Managed Care Organizations (MCOs) are playing an increasingly important role in facilitating coordinated care for children with complex needs. The report highlights innovative efforts of ACAP-member Safety Net Health Plans to deliver better-coordinated, higher-quality care to children with special health care needs and improve outcomes.
“As policymakers contemplate dramatic changes, it bears noting that Medicaid is a more complex program than is generally appreciated. This paper shows some of the extraordinary efforts of Safety Net Health Plans to provide solutions for children who have high levels of need – and their families,” said ACAP CEO Margaret A. Murray. “Like all of us, children with special health care needs rely on consistency, quality, and above all, coverage. The stories and initiatives in this report underscore the reasons why changes to Medicaid at the Federal level should be made deliberatively and with input from key stakeholders.”
“A significant proportion of children with special health care needs are covered by Medicaid. These children account for a large share of service utilization and pediatric Medicaid spending,” said Cheryl Austein Casnoff, Senior Fellow, NORC at the University of Chicago. “As more children move to Medicaid managed care programs, it’s critical to better understand the increasing roles that managed care organizations play in addressing the complex needs of these children and their families. This report provides needed insight into health plans’ roles and their contributions.”
Among the techniques profiled in the report:
- Partnerships with providers to foster communication and training, such as learning collaboratives;
- Innovative care coordination models, which include a single point of contact, a team-based model, embedded staff at primary care practices, among others;
- Integration of behavioral health care with other care, especially through the development and sharing of comprehensive care plans to document all services, inclusive of behavioral health;
- Supporting non-medical needs of members and families, such as transportation, housing, education, social services, legal support, nutrition assistance, and support for caregivers;
- Effective data mining and analysis, including predictive modeling and risk stratification of claims or care management data to identify children in need of support, or of preventive or other care;
- Measuring quality of care and investing in quality improvement, including the use of measures specific to CSHCN, including those that address concurrent use of multiple medications and use of antipsychotics; and
- Innovative payment models such as support for physician practices to implement medical home models and incentive payments to providers to finance and promote engagement in the care coordination process.
The study is available in full at www.communityplans.net.
About ACAP
ACAP represents 59 nonprofit Safety Net Health Plans in 28 states, which collectively serve more than seventeen million people enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), Marketplaces and other publicly-supported health programs.
For more information, visit www.communityplans.net.
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