Health Care For Kids Is Not Like Health Care For Adults
In health care for adults on Medicaid, the focus is on improving outcomes and saving money for the common chronic diseases, so a “chronic care model” was developed to guide management of chronic conditions in adults. For children, however, a corresponding amount of effort should be focused on preventing these chronic diseases and preventing health disparities experienced by children with the poorest health outcomes.
The Intensive Preventive Care Model
Because children in low income families have more socioeconomic barriers to good health outcomes, they need a higher intensity of preventive care than commercially insured children. Children on Medicaid experience over 30 health disparities (significantly poorer health outcomes than commercially insured children). Although many of the these poor outcomes are related to a variety of issues associated with poverty or near-poverty, most of those outcomes can be improved by access to a good medical home and the preventive care, screening, and early intervention provided at well child visits. They also have higher needs for care coordination.
If your practice provides well child visits for children covered by Medicaid at the ages recommended by the American Academy of Pediatrics, recommended vaccinations, and the screening and interventions recommended below, you will be addressing many of those health disparities. And your total compensation will be higher than for most commercial health plans.
CCHAP proposes that for children in low income families, most of the health care dollar should be focused on an “Intensive” Preventive Care Model (which has to be a cooperative effort of community-based organizations, governmental agencies and medical homes) that:
- Screens for, and helps address, psycho-socio-economic barriers and follows up to be sure the family received help
- Provides care coordination and navigation
- Assists children to maintain continuous enrollment in a health insurance plan (public or private)
- Ensures children access all appropriate preventive care visits
- Provides intensive health education to promote prevention and wellness.
- Ensures children are fully immunized at appropriate ages
- Provides timely developmental screening, referral and documentation that treatment was received
- Provides timely teen depression screening, referral and documentation that treatment was received
- Provides timely post-partum depression screening, referral and documentation that treatment was received
- Provides oral health counseling, thorough dental exams and application of fluoride sealants to the teeth of toddlers and preschoolers…or ensures the child sees a dentist regularly for these services.
- Provides nutrition and fitness counseling to all patients
- Screens for obesity and provides or refers to appropriate obesity counseling.
- Actively promotes safety and accident prevention
- Provides 24 hour a day triage and advice and assists families to access care in the medical home rather than the ED
- Utilizes asthma clinical care guidelines, asthma registries and appropriate preventive measures to improve the outcomes for children with asthma
- Utilizes parent and teacher questionnaires and clinical guidelines for ADHD
- Provides enhanced care coordination for CSHCN and foster children
- Integrate mental health into the primary care setting
- Develops relationships with medical homes for adults that are willing to accept youth covered by Medicaid and CHP+ as they transition to adulthood.
It takes an entire community to implement this model. Medical homes do not have the resources or funding to provide all of the elements of this model. It requires a whole host of community-based organizations and governmental agencies coordinating efforts together to effectively provide this intensive care.
The American Academy of Pediatrics publishes a “periodicity schedule” [pdf] which recommends a schedule of preventive activities that are in the best interest of children. Colorado Medicaid accepts the periodicity schedule of the American Academy of Pediatrics as a guideline for preventive care. The table linked to below describes potential preventive activities that, if implemented for children covered by Medicaid, could help reduce their health disparities. Plus, the overall well child care compensation would be higher than for commercial health plans.