Transcript Document

Medical Homes For Children in Foster Care:
A Proposal for CCNC Consideration
Proposal collaboratively developed by:
NC Pediatric Society Foundation & Benchmarks
August 2, 2012
Population Characteristics
• 14,266 children served in foster care during
SFY 2010-11
• 4,700 entered; 3,400 exited; 9,000 on any
given day
• Age Distribution (end of month for 2010-2011)
– 38% 0-5 years old
– 30% 6-12 years old
– 25% 13-17 years old
• 60% leave within 1.5 years
Population Needs
• American Academy of Pediatrics: children in
foster care have higher prevalence of physical,
developmental, dental and behavioral health
conditions than any other group of children
• Children in foster care cost Medicaid more
than three times what non-disabled,
Medicaid-eligible children cost due to their
complex physical and behavioral health needs
(2008, Center for Health Care Strategies)
Buncombe County
Level
III/IV
Therapeutic
Foster Care
Level I Group Care
Family Foster Care
204 Children in DSS Custody (2/29/2012)
PRTF – 14 Children
• Age range: 7.5 yrs – 18 yrs
• Length of Time in PRTF Range: 3 mo – 12
mo.
• Median Length of Time in PRTF: 6.5 mo
• Median # of MH Placements: 8 (range:
2-13)
• Median # of Hospital: 2 (range: 0-8)
• 8 out of 14 (57%) entered DSS custody
when they were 5-8 yrs old and have
been in custody for a median of 8 yrs
• 6 out of 14 (42%) entered DSS custody
when they were 11-16 yrs old
ESTIMATED COST FOR PRTF CARE:
$1.475 million
Importance of Medical Home
• Linking children to Carolina Access II homes is
first step
– As of Dec 2011, 63% of 0-4 years enrolled and
52% for 0-20 (this includes adopted children)
• Enhancing capacity of medical homes to serve
this high need population is the next step
– Challenges include complex coordination needs;
confidentiality issues; transience of the
population; and the need for a “trauma lens” in
assessment and service delivery
Proposed Medical Home Functions
• Collaboration with local Department of Social Services
• Coordination or provision of brief health screenings within 7
days of entering care
• Coordination or provision of more comprehensive health,
behavioral health, developmental, and substance abuse
screenings/assessments within 30 days
• Ongoing coordination of referrals to and communications
with array of service providers
• Coordination with LME-MCO to ensure care coordination of
behavioral health services
• Education of caregivers (e.g. foster and kinship parents)
• Provision/receipt of t.a. and consultation within CCNC
network on serving this population (clinically,
administratively)
Quality Improvement Initiative
• Provide support to pilot primary care practices in
select CCNC networks:
– Professional education on trauma and the unique
health/behavioral health needs of children in foster
care;
– Clarification of confidentiality issues;
– Training and support for appropriate billing;
– T.A. and support in the development of screening,
assessment, and service delivery strategies aligned
with the requirements of the foster care system
Proposed Performance Indicators
• Comparison of cost PM/PM of CCNC enrolled foster children vs. other
Medicaid child pop.
• Decreased use of high-end services including Emergency Department
visits and hospitalizations
• Decreased use of psychotropic medications
• Increased compliance with Health Check well-child periodicity
schedules
• Increased timely compliance with the ACIP immunization schedule
• Increased rate of annual dental visits
• Continued use of same health care providers/practice during foster
care placement
• Levels of physician, patient and caregiver satisfaction
• Impact of provider education on Medicaid coding strategies for
assessing and treating children in foster care to ensure financial
sustainability