A pilot project to provide coordinated care to children insured by Medicaid resulted in more Connecticut children receiving preventive dental services, mental health care and well-child visits, according to a new report by the Child Health and Development Institute of Connecticut, Inc.
“Care coordination is especially important for children, as they benefit most when their needs are detected early and they receive intervention services,” the report says. “The primary care medical home is an ideal venue for detecting children’s problems at the earliest possible age and connecting families to helpful interventions and supports outside of the primary care site.”
The evaluation of the “Health Outreach for Medical Equality” project, dubbed “H.O.M.E.,” found that adding care coordinators to work with low-income children in the HUSKY insurance program boosted the percentage of Hartford children ages 2 and younger using dental services – 34 percent for those who received care coordination, vs. 25 percent of Hartford children overall.
In addition, children who received H.O.M.E. services accessed behavioral and mental health services at a significantly higher rate than the overall Hartford HUSKY population.
The increased access to dental and mental health care “pays off tremendously in the long run,” in terms of both health outcomes and cost savings, as problems are addressed earlier, said Lisa Honigfeld, vice president for health initiatives at the Child Health and Development Institute.
The H.O.M.E. project was coordinated by the Hispanic Health Council and the Connecticut Children’s Medical Center, which partnered to provide outreach and care coordination for patients in the Charter Oak Health Center at Children’s Medical Center (the Primary Care Center) who were insured by HUSKY. The project was funded by the Children’s Fund of Connecticut, the Hartford Foundation for Public Giving and the state Department of Social Services.
While project leaders expected that the coordinated care would cut down on the number of emergency room visits, the opposite was true: Children in H.O.M.E. in two age groups – 6 to 8, and 15 to 17 -- were more likely to visit ERs than their counterparts.
Honigfeld said the finding was “surprising” and of concern, since a goal of care coordination is to decrease avoidable emergency room visits. But the evaluation suggests two reasons for the increased number of ER visits: H.O.M.E. participants tended to be a higher-risk population, and, because they received primary care services at Connecticut Children’s, they gravitated towards the medical center after-hours and on weekends when they needed care.
Honigfeld said that while national health care reform is “banking heavily on efforts to keep people out of emergency rooms, that really will not happen unless there’s an expansion of primary care capacity and access.”
Earlier studies have indicated that 40 percent of Connecticut children enrolled in HUSKY were seen in emergency care settings in 2006. A third of them sought ER care for conditions that could have been treated in primary care.
Fewer than 25 percent of Connecticut-based pediatric and family medicine practices report that they engage in formal care coordination activities, the report says. Almost half of all the practices said that care coordination is done on an as-needed basis, without a formal mechanism. Key barriers to providing coordinated care include a lack of time, reimbursement, staff, and integrated data systems that would support care linkages for patients.
The report advocates extra reimbursement to clinical practices for care coordination services, in both the public and private health insurance sectors.
Elements of the H.O.M.E project are being incorporated into ongoing efforts to coordinate care for Hartford area children that can be replicated in other communities, Honigfeld said. She noted that Connecticut has made significant progress in establishing a statewide “medical home” system through Medicaid that encourages coordinated care for children and adults. The state is using a medical home model for at-risk children enrolled in Children & Youth with Special Health Care Needs (CYSHCN) program.