center for children with special needs 1 medicaid managed care for children with special health care...

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Center for Children with Special Needs

Medicaid managed care for children with special health care needs:Which services need to improve?

Jacquie Stock, MPH

Ginny Sharp, MA

Stacey DeFries, MSW

Becky McAninch-Dake

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Objectives

• Response to national performance measures.

• Establish source for monitoring quality of Medicaid managed care for children with special health care needs (CSHCN).

• Identify strategies for improving quality in systems of care.

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CAHPS® 2.0H Child Survey• Initiated 1995 by

– Agency for Health Care Policy and Research

– Centers for Medicare & Medicaid Services

• “set of standardized surveys that assess patient satisfaction with the experience of care” (HEDIS®-Health Plan Employee Data and Information Set, a registered trademark of NCQA.)

• A need to monitor and report on quality of health services across health plans.

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Child Survey Questions• Consumers Rate

– all health care from plan– health plan – personal doctor or nurse– specialist seen most often

• Areas covered– courteous and helpful staff– customer service– getting care quickly– getting needed care– how well doctors and other providers communicate

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Children with Chronic Conditions Measurement Set

• Access to prescription medication• Access to specialized services• Family centered care

– personal doctor or nurse who knows child– shared decision making– getting needed information

• Coordination of care• CSHCN Screener

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CSHCN Screener• 15 question survey based screening tool• Designed to identify CSHCN

– According to Maternal Child Health Bureau definition

• Development– 3 years– 30 organizations coordinated by

Foundation for Accountability (FACCT)

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Who Qualifies as a CSHCN?• Needs or uses prescription medications AND

– need due to medical, behavioral or other health condition– duration or expected duration of condition is at least 12

months

• Needs or uses more medical care, mental health or education services than usual AND…

• Limited or prevented in ability to do things AND…

• Needs or gets special therapy (OT, PT, Speech) AND …

• Any emotional, developmental, or behavioral problem for which treatment or counseling needed AND …

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Methods and Sample• Random sample, children 0-12 Yrs, enrolled in

Washington State Medicaid managed care health plans

• Children with a probable chronic condition are over-sampled

• Mail or telephone to parent/guardian

• Response rates

– contact rate=47%

– complete response rate=93% (n=7,119)

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How Children Qualified on the CSHCN Screener

74%

51%42%

29%17%

0%

10%

20%

30%

40%

50%

60%

70%

80%

prescriptionmedication

medical care,mental health,educational

services

emotional,developmental,

behavioralproblem needing

treatment orcounseling

limited orprevented inability to do

things

special therapy(OT, PT,Speech)

33% (2,377) met CSHCN Screener

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Number of ways children qualify on CSHCN Screener

“Definition Types”• Dependency

– upon prescription medication

• Service Use– medical care, mental health, educational,

special therapy, treatment or counseling for emotional, developmental, behavioral problem

• Functional Limitations

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Number of CSHCN Screener Definitions Met

2 of 338%

all three18%

1 of 3 44%

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Differences in Samples of CSHCN and Non-CSHCN

• CSHCN older– 9.24 mean yrs vs. 7.88 yrs (p<.000)

• School age vs. early intervention age (0-35 months)

– 91% vs. 80% OR=2.64 CI 2.25, 3.10

• Male – 63% vs. 50% OR=1.654 CI 1.495, 1.83

• “White” non-Hispanic vs. not

– 75% vs. 68% OR=1.394 CI 1.25, 1.56

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Respondents with CSHCN and Non-CSHCN Differ

• not parent of child– 11% vs. 5% OR=2.33 CI 1.862, 2.678

• 45 yrs or older vs. less than 45 yrs– 17% vs. 12%OR=1.58 CI 1.38, 1.82

• female– 92% vs. 90%OR=1.33 CI 1.11, 1.59

• HS grad vs. not– 89% vs. 86%OR=1.36 CI 1.16, 1.58

• English as primary language – 95% vs. 86%OR=3.22 CI 2.61, 3.97

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Rating Providers• At plan entry, big vs. small/no problem

getting personal doctor or nurse you’re happy with.– CSHCN 11% vs. 6% n=3,127

OR 1.74 CI 1.32, 2.3

• Personal doctor or nurse rated 0-5 vs. 6-10 (0=worst).– CSHCN 8% vs. 6% n=5,702

OR 1.43 CI 1.15, 1.78Multivariate analysis controlling for child and respondent demographic factors.

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• Health care from all docs/providers rated 0-5 vs. 6-10.– CSHCN 10% vs. 6% n=5,405

OR 1.8 CI 1.46, 2.22

• Providers respect what you say, sometimes/never vs. usually/always.– CSHCN 8% vs. 6% n=5,371

OR 1.48 CI 1.18, 1.85– English not primary language

OR=1.67 CI 1.17, 2.37

Multivariate analysis controlling for child and respondent demographic factors.

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Big vs. Small/No Problem Getting Needed Care• Getting care you or doctor believed child

needed– CSHCN 5% vs. 2% n=5,407


OR1.88 CI 1.11, 3.18

• Getting child’s prescription medicine– CSHCN 8% vs. 3% n=4,304

OR 2.67 CI 1.96, 3.65


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• Getting OT, PT, Speech– CSHCN 22% vs. 13% n=480

OR 2.14 CI 1.17, 3.92– Respondent is high school graduate

OR 2.99 CI 1.02, 8.67

• Getting referral to specialist– CSHCN 14% vs. 9% n=1,780


OR 1.77 CI 1.03, 3.03

• Delays in child’s care while waiting for plan approval– CSHCN 6% vs. 2% n=5,390

OR 2.99 CI 2.15, 4.17

Big vs. small or no problem…


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• Got needed help or advice sometimes/never vs. usually/always when called doctor or nurse– CSHCN 12% vs 10% n=4,534

OR 1.37 CI 1.12, 1.67– Child ethnicity other than “white non-

Hispanic”OR 1.33 CI 1.07, 1.65

– English not primary languageOR 2.18 CI 1.60, 2.97


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Customer ServiceBig vs. small or no problem …


• Called or wrote plan with complaint or problem– CSHCN 8% vs. 3% n=6,848

OR 2.78 CI 2.20, 3.52

• Getting help from customer service– CSHCN 21% vs. 10% n=1,168

OR 2.15 CI 1.52, 3.03– Birth up to three years

OR .58 CI .34, .98– English not primary language

OR .38 CI .15, .92

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• Finding or understanding written information from plan– CSHCN 11% vs. 7% n=1,360

OR 1.73 CI 1.15, 2.60

• Problem with paperwork from plan– CSHCN 16% vs. 9% n=1,422

OR 1.88 CI 1.34, 2.63– Birth up to three years

OR .5 CI .29, .87– High school grad vs. not

OR .54 CI .33, .90

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8%13%

92%87%

0%

20%

40%

60%

80%

100%

120%

CSHCN Not CSHCN

6-10(10=best)

0-5(0=worst)

Most rate experiences with health plan high, but respondents with CSHCN more likely to rate all experiences from health plan lower.

N=6,817OR 1.63 CI 1.38, 1.92

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Guided by these findings, health plans can improve services for CSHCN and families by identifying procedures within the plan that may result in delayed care, not getting care, and how paperwork and communication can improve for families.

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Contact Information:Jacquie Stock, MPHResearch AssociateCenter for Children with Special NeedsChildren’s Hospital and Regional Medical Center(206) [email protected]

Stacey DeFries, MSWAssessment CoordinatorChildren with Special Health Care Needs ProgramWashington State Department of Health(360) [email protected]

center for children with special needs 1 medicaid managed care for children with special health care...

Documents

special needs

health care policy

needed care

systems of care

mental health

quality of health services

number of ways children

health condition duration