As implementation of the Affordable Care Act continues, and as Congress continues to discuss proposals to reign in health care costs, it’s important legislators take note of impactful work by hospitals, non-profits, and other groups that improves care for children in Medicaid while reducing costs – both now and in the future.
To that end, on July 12, the Children’s Hospital Association, in cooperation with the Congressional Children’s Health Care Caucus, hosted a briefing on Capitol Hill which explored three unique health care programs for kids. Titled “Keys to Kids Care: Unlocking Ideas to Improve Care for Kids in Medicaid,” the briefing brought together three panelists with unique insights into how Medicaid serves children and highlighted innovative efforts that improve health outcomes as well as help families better manage their children's health.
Dr. Floyd J. Malveaux of the Merck Childhood Asthma Network (MCAN) spoke to asthma as the most common chronic condition among children and second most expensive. Treating asthma costs $8 to $10 billion annually and “is widespread, serious, and costly.” Half of annual asthma medical expenditures are paid through Medicaid. That’s the bad news. The good news is the number of kids with asthma can be lowered, and costs reduced, through evidence-based interventions that help identify kids with potential problems and lower their asthma risk. Dr. Malveaux illustrated numerous successful programs such as the HEAL Program in post-Katrina Louisiana that help reduce asthma triggers in homes and dramatically reduce long-term costs.
Dr. Jocelyn Lawrence, outlined a unique program that targets potential health issues in kids before they become serious, thereby reducing long-term costs of care. Dr. Lawrence talked about the work done by the Dr. John T. Macdonald Foundation’s School Health Initiative, which teams public schools in Miami-Dade County team with the University of Miami Leonard M. Miller School of Medicine to provide access to primary care and nursing in underserved Florida public schools. Clinics are set up in the schools themselves, making it easier for children to make appointments. Dr. Lawrence noted that 85 percent of the kids at these schools are on reduced lunch programs, 32 percent are obese or overweight, and an estimated 25 percent have serious mental health issues. The School Health Initiative provides physical exams, immunizations, and many others to these kids free of charge. As a result, there has been a reduction in 911 calls and emergency room visits as well as vastly improved attendance rates in schools. Last year, a $4 million innovation award grant from the Centers for Medicare and Medicaid Services helped add dental and mental health services to the program, and extended services to the students’ families. These preventative services will, in the long run, save millions in emergency room visits and unpaid medical bills. More importantly it will vastly improve the quality of life for these kids.
Dr. Sandy Melzer of Seattle Children’s Hospital focused on providing care for medically complex kids in the Medicaid system. These children have chronic, physical, developmental, behavioral, or emotional conditions, often affecting two or more body systems and requiring intensive care coordination to avoid excessive hospitalizations or emergency department visits. Typically they lack a medical home and likely have multiple providers, not all of whom are in communication with each other. In addition, many of these kids visit Seattle Children’s from outside Washington state triggering issues with the Medicaid programs in patients’ home states.
There are 2 million children enrolled in Medicaid who are considered medically complex. Due to the level and intensity of care these children need and the cost of providing such specialized care, this population accounts for approximately 40 percent of all Medicaid spending on children. Building a sustainable model to provide coordinated care for these kids presents a number of challenges, the biggest being that care coordination is extremely difficult (in terms of tracking the patients) and expensive (because of staff and IT needs).
But, as Dr. Melzer noted, there are numerous ways to save money. For example, interventions focusing on inpatient care and drugs can reduce costs by nine percent by providing care plans and medication reviews to patients, and can also reduce readmissions. Dr. Melzer also referenced a recent proposal by the Children’s Hospital Association, which would createnationally designated pediatric networks to support care coordination for medically complex children.
The Medicaid Matters for Kids briefing series is also sponsored by the American Academy of Pediatrics, Family Voices, First Focus, Georgetown Center for Children and Families and March of Dimes.For more details on the remaining briefings in the series, please visit www.childrenshospitals.net/medicaidmatters.