Many low-income children persistently lag behind their peers cognitively, socially, physically, and emotionally due to difficult social and emotional environments, a lack of developmental services, and other challenging circumstances. This resource for Medicaid managed health plans and other organizations—based on the experiences of 11 health plans—presents a quality framework for designing initiatives to improve developmental services that can be customized to work in different clinical and administrative areas. It also highlights strategies for improving the delivery of services, including the early identification of developmental disabilities, increasing outreach to members, enhancing provider partnerships, improving reimbursement and referral practices, and recognizing potential returns on health plan investment.
The Issue: Every year, tens of thousands of low-income young children enter school unprepared to succeed because they have not had the benefit of high-quality developmental services. Yet, research shows that early intervention programs and clinical services can prevent or ameliorate some of these problems and place "at risk" children on a more positive developmental trajectory. While many low-income children are covered through publicly financed programs such as Medicaid and the State Children's Health Insurance Program (SCHIP), the Medicaid managed care organizations that serve significant numbers of these children are struggling to ensure the delivery of consistent and high-quality developmental services.
Organization: Center for Health Care Strategies (CHCS)
Date of Implementation: October 2005
Target Population: Medicaid health plan medical and quality improvement directors, state Medicaid and SCHIP directors, pediatric professional organizations, clinicians
The Intervention: This resource, developed by the CHCS' Best Clinical and Administrative Practices (BCAP) initiative, can assist in the early identification and treatment of developmental delays by providing Medicaid managed care plans with practical approaches to improving the quality of their well-child care and developmental services. Medicaid managed care plans are well-positioned to work with members and providers to improve early developmental screening. This resource reflects the experiences of 10 health plans and one state primary care case management program that collaborated to develop, pilot, and refine innovative practices for this population. This resulting report reviews the BCAP Quality Framework, which was adapted from learning models developed by the Institute for Healthcare Improvement and other organizations. The framework offers health plans an opportunity to become more of a quality improvement leader by:
- offering a template for designing quality initiatives;
- facilitating the testing and analysis of changes;
- enabling health plans to measure and evaluate their success;
- and promoting the ongoing use of best practices.
Also included in the report is information about using standardized developmental screening tools during well-child visits to identify infants and young children with developmental delays at the earliest possible stage. The report also explores how health plans can inform and engage parents in identifying developmental problems by asking them to complete developmental questionnaires, by providing educational materials and reminders for well-child visits, and by conducting outreach events in the community.
Likewise, the report illustrates how health plans can work closely with primary care practitioners to reduce administrative burdens and improve workflow. For example, reminder systems can encourage the use of preventive services. The report authors also suggest rewarding quality care with incentives and providing training on development screening and interventions. In addition, the report reviews how to improve reimbursement rates for developmental screening and testing. For example, one participating health plan paid physicians $25 for submitting claims for these services and promoted the incentive through letters to providers and articles in a provider newsletter. In addition, the report explains how one participating plan improved the tracking of referrals. The plan, CommunityCARE in Louisiana, implemented use of a standardized tracking referral form that is collected from providers on a monthly basis.
The report similarly gives guidance about how health care plans can demonstrate returns on investments. For example, improving the quality of child services plan-wide may lead to improved services for not only Medicaid recipients but all plan members. It may also lead to being considered more of a quality-improvement leader by purchasers, policymakers, and other health plans. Lastly, case studies are provided to illustrate how plans, including Molina Healthcare of Michigan, BlueCross BlueShield of Tennessee, and the Lovelace Community Health Plan, used the BCAP Quality Framework to improve child development services in Medicaid managed care settings. To read the toolkit, visit the CHCS Web site.
For More Information: Purvi Kobawala Smith, Program Officer, CHCS, [email protected]