How Health System Transformation Efforts are Improving Access to Care for Children and Youth

States are rapidly undertaking major reforms within their health care delivery systems. Though not often specifically targeting children and youth, these reforms offer opportunities to positively impact how this population accesses care. In a recent NASHP webinar several states described how their health system transformation efforts are doing so.

Massachusetts State Innovation Model Grant: Massachusetts Child Psychiatry Access Project
In 2013, Massachusetts used a portion of their State Innovation Model (SIM) testing grant, which focuses on payment reform, delivery system transformation, and cost and quality accountability to increase access to children’s behavioral health consultations.

Christina Fluet, the Director of Planning and Policy Development at the Massachusetts Department of Mental Health, shared how SIM grant dollars were used to support and expand the efforts of the Massachusetts Child Psychiatry Access Project (MCPAP). The Project is a statewide system of child psychiatry consultation teams designed to help pediatricians and family physicians meet the needs of children with behavioral health challenges by providing telephone consultations with physicians, face-to-face consultations, community resource and referral information, as well as training and education for providers. This successful model has been adopted by 29 other states. The SIM grant funding allowed for Massachusetts to restore MCPAP services to full-time, increase utilization of services among primary care providers, develop sustainability strategies, increase needed services to address adolescent substance use and evaluate outcomes from grant activities. The Project is also exploring sustainability strategies for when SIM funding ends.

New York Health Home Program: Expanding Services to Children
As part of a larger, state-wide health system transformation effort, and through the authority granted under section 2703 of the Affordable Care Act, New York established a Health Home program which seeks to provide a comprehensive system of care coordination for Medicaid enrollees with chronic conditions. Health home providers integrate and coordinate all primary, acute, behavioral health, and long-term services and supports. Using this program, specific efforts are underway to improve access to these services specifically for children and youth.

Lana Earle, the Deputy Director in the Division of Program Development and Management at the New York State Department of Health, shared how the state is tailoring their existing adult health home model to serve the unique needs of children and youth. This tailoring process has included extensive collaboration with the Centers for Medicare and Medicaid Services and the Substance Abuse and Mental Health Services Administration, stakeholders, providers, and plans. In 2015, New York received approval for a Pediatric Health Home State Plan Amendment (SPA) from CMS with amendments to expand health home eligibility criteria and include child-specific conditions and definitions (complex trauma, serious emotional disturbance and a pediatric-specific BMI definition). The SPA also included an amendment for the use of the Child and Adolescent Needs and Strengths tool (CANS-NY), a uniform assessment tool, to be used in creating a care plan, measuring acuity, determining a per-member per-month rate structure for children, and home and community-based services eligibility for new array of services. For those interested in more information on New York’s pediatric health home model, they have posted a vast amount of information for the public on the website.

Ohio Accountable Care Organization: Partners for Kids
Partners for Kids is a private Accountable Care Organization (ACO) that is a partnership between Ohio’s Nationwide Children’s Hospital and more than a thousand physicians who coordinate care for over 300,000 Medicaid enrolled children in 34 counties in the state. Kelly Kelleher, the Director of the Center for Innovation in Pediatric Practice at Nationwide Children’s Hospital, explained how Partners for Kids is responsible for improving the quality of care and lowering costs for their enrollees by receiving capitated fees from Ohio’s five current Medicaid managed care plans and paying caregivers for the services provided.

As one of the country’s oldest and largest pediatric ACOs, Partners for Kids has learned important lessons in making this health system transformation effort successful. Kelly stressed the importance of state support for ACOs, access and sharing of data among providers and Medicaid, and the inclusion of health in different policy areas (transportation, housing, employment, etc.). Because of the ability to analyze data, Partners for Kids has been able to show cost savings and positive health outcomes for enrollees, something other states may be interested in as they implement or explore the use of pediatric ACOs.

If you are interested in hearing more about any of the above state experiences, please refer to the slides from the NASHP webinar or a recording of the presentations.