Access to Care: AnInsurance Card thatMeans Something
Getting to the Finish Line
July 14, 2009
Amy Rosenthal, New England Alliance for Children’s Health
Tom Vitaglione, North Carolina Action for Children
Joe Touschner, Center for Children and Families
Access to care
•System-wide challenge
•Evaluating Medicaid and CHIP:what is the appropriatecomparison?
•Primary vs. specialty
Medicaid/CHIP Coverage andAccess to Care
Source: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007.Summary of Health Statistics for U.S. Children: NHIS, 2007. Note: Questions about dental care were analyzed for childrenage 2-17. Respondents who said usual source of care was the emergency room were included among those not having ausual source of care. An asterisk (*) means in the past 12 months.
Recent studies: Mixed Results
•Ku 2009
–After adjusting for health status andsociodemographic factors, there were no significantdifferences between Medicaid children and theprivately insured in emergency, outpatient, orinpatient hospital use; there was higher prescriptiondrug use among Medicaid children.
•Hoilette, Clark, Gebremariam, & Davis2009
–Among the insured, publicly insured children hadtwice the odds of reporting an unmet needcompared with privately insured children.
Recent studies: Mixed Results
•Skinner & Mayer 2007
–Literature review focused on specialty care showedthat children with public coverage have better accessto specialty care than uninsured children, but pooreraccess compared to privately insured children.
•Selden & Hudson 2006
–Differences between public and private coverage arereduced (and often reversed) when we control forother characteristics of children and their families.
Oral health care
•Less than 30% of children inMedicaid obtain any dentalcare in a year
•25% receive preventive dentalcare
•Corresponding rates forprivately insured children areabout double
Oral health care
•Dentist participation in Medicaidis low
•Low provider payments are areonly one reason:
–41 states increased payments1999-2006, but only 25 increasedutilization
–But no state increased utilizationwithout increasing payment rates
Access to care in Medicaid and CHIP
•Measured nationally, access topreventive and primary care inMedicaid and CHIP is on par withaccess among children who haveprivate insurance.
•Oral health and specialty caremay have challenges
•How much does state experiencevary?
Problem
•Chronic illness accounts for vast amounts ofhealthcare costs
•Majority of chronic patients do not receiveappropriate care
•Primary care providers feel limited in theirability
•Local public health, mental health, andcommunity providers are not coordinated withPCPs
Problems as Goals
•Need to improve outcomes
•Need to control costs
Primary Strategies
•Provide a medical home
•Develop community networks capable ofmanaging care
•Develop systems to improve the care ofchronic illness
Community Care NC
•14 networks with more than 3500 PCPs (1200medical homes)
•Includes local health, mental health, hospitalsand safety net clinics
•Each has P/T medical director, a clinicalcoordinator, a PharmD, and care managers
•PCPs receive $2.50 pm/pm
•Netwrorks receive $3.00 pm/pm
Evidence-Based Guidelines
•Adopted by consensus
•All networks: Asthma
Diabetes
Pharm Mgt.
ED Utilization Mgt.
•Optional: Child Development
ADD/ADHD
Gastroenteritis
Others (hi cost; hi utilization)
Results/Care
•Asthma
34% lower hospital admission rate
8% lower ED rate
•Diabetes
15% increase in quality measures
•Child Development
Developmental Screening rate 15% (2000)
85% (2005)
Results/Money
•2004
Cost $10.2 m
Savings $225 m
•2006
Savings $231m
For more information
Tricia Brooks
202-365-9148
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