Transcript Center for Children with Special Needs

Medicaid managed care
for children
with special health care needs:
Which services need to improve?
Jacquie Stock, MPH
Ginny Sharp, MA
Stacey DeFries, MSW
Becky McAninch-Dake
1
Center for Children with Special Needs
Objectives
• Response to national performance
measures.
• Establish source for monitoring quality
of Medicaid managed care for children
with special health care needs (CSHCN).
• Identify strategies for improving quality
in systems of care.
2
Center for Children with Special Needs
CAHPS® 2.0H Child Survey
• Initiated 1995 by
– Agency for Health Care Policy and Research
– Centers for Medicare & Medicaid Services
• “set of standardized surveys that assess
patient satisfaction with the experience of
care” (HEDIS®-Health Plan Employee Data and Information
Set, a registered trademark of NCQA.)
• A need to monitor and report on quality of
health services across health plans.
3
Center for Children with Special Needs
Child Survey Questions
• Consumers Rate
–
–
–
–
all health care from plan
health plan
personal doctor or nurse
specialist seen most often
• Areas covered
–
–
–
–
–
courteous and helpful staff
customer service
getting care quickly
getting needed care
how well doctors and other providers communicate
4
Center for Children with Special Needs
Children with Chronic Conditions
Measurement Set
• Access to prescription medication
• Access to specialized services
• Family centered care
– personal doctor or nurse who knows child
– shared decision making
– getting needed information
• Coordination of care
• CSHCN Screener
5
Center for Children with Special Needs
CSHCN Screener
• 15 question survey based screening tool
• Designed to identify CSHCN
– According to Maternal Child Health Bureau
definition
• Development
– 3 years
– 30 organizations coordinated by
Foundation for Accountability (FACCT)
6
Center for Children with Special Needs
Who Qualifies as a CSHCN?
• Needs or uses prescription medications AND
– need due to medical, behavioral or other health
condition
– duration or expected duration of condition is at
least 12 months
• Needs or uses more medical care, mental health or
education services than usual AND…
• Limited or prevented in ability to do things AND…
• Needs or gets special therapy (OT, PT, Speech) AND …
• Any emotional, developmental, or behavioral problem
for which treatment or counseling needed AND …
7
Center for Children with Special Needs
Methods and Sample
• Random sample, children 0-12 Yrs,
enrolled in Washington State Medicaid
managed care health plans
• Children with a probable chronic condition
are over-sampled
• Mail or telephone to parent/guardian
• Response rates
– contact rate=47%
– complete response rate=93% (n=7,119)
8
Center for Children with Special Needs
How Children Qualified on the
CSHCN Screener
80%
33% (2,377) met CSHCN Screener
70%
74%
60%
50%
51%
40%
42%
30%
29%
20%
17%
10%
0%
special therapy
(OT, PT,
Speech)
limited or
prevented in
ability to do
things
emotional,
developmental,
behavioral
problem needing
treatment or
counseling
medical care,
mental health,
educational
services
prescription
medication
9
Center for Children with Special Needs
Number of ways children
qualify on CSHCN Screener
“Definition Types”
• Dependency
– upon prescription medication
• Service Use
– medical care, mental health, educational,
special therapy, treatment or counseling for
emotional, developmental, behavioral problem
• Functional Limitations
10
Center for Children with Special Needs
Number of CSHCN Screener
Definitions Met
all three
18%
1 of 3
44%
2 of 3
38%
11
Center for Children with Special Needs
Differences in Samples
of CSHCN and Non-CSHCN
• CSHCN older
– 9.24 mean yrs vs. 7.88 yrs (p<.000)
• School age vs. early intervention age (0-35 months)
– 91% vs. 80%
OR=2.64
CI 2.25, 3.10
OR=1.654
CI 1.495, 1.83
• Male
– 63% vs. 50%
• “White” non-Hispanic vs. not
– 75% vs. 68%
OR=1.394
CI 1.25, 1.56
12
Center for Children with Special Needs
Respondents with CSHCN and
Non-CSHCN Differ
• not parent of child
– 11% vs. 5%
OR=2.33
CI 1.862, 2.678
• 45 yrs or older vs. less than 45 yrs
– 17% vs. 12% OR=1.58
CI 1.38, 1.82
• female
– 92% vs. 90% OR=1.33
CI 1.11, 1.59
• HS grad vs. not
– 89% vs. 86% OR=1.36
CI 1.16, 1.58
• English as primary language
– 95% vs. 86% OR=3.22
CI 2.61, 3.97
13
Center for Children with Special Needs
Rating Providers
• At plan entry, big vs. small/no problem
getting personal doctor or nurse you’re
happy with.
– CSHCN 11% vs. 6% n=3,127
OR 1.74
CI 1.32, 2.3
• Personal doctor or nurse rated 0-5 vs. 6-10
(0=worst).
– CSHCN 8% vs. 6% n=5,702
OR 1.43
CI 1.15, 1.78
Multivariate analysis controlling for child and
respondent demographic factors.
14
Center for Children with Special Needs
• Health care from all docs/providers
rated 0-5 vs. 6-10.
– CSHCN 10% vs. 6%
OR 1.8
n=5,405
CI 1.46, 2.22
• Providers respect what you say,
sometimes/never vs. usually/always.
– CSHCN 8% vs. 6%
n=5,371
OR 1.48 CI 1.18, 1.85
– English not primary language
OR=1.67 CI 1.17, 2.37
Multivariate analysis controlling for child
and respondent demographic factors.
15
Center for Children with Special Needs
Big vs. Small/No Problem
Getting Needed Care
• Getting care you or doctor believed child
needed
– CSHCN 5% vs. 2% n=5,407
OR 3.24
CI 2.32, 4.53
– English not primary language
OR1.88
CI 1.11, 3.18
• Getting child’s prescription medicine
– CSHCN 8% vs. 3% n=4,304
OR 2.67
CI 1.96, 3.65
Multivariate analysis controlling for child
and respondent demographic factors.
16
Center for Children with Special Needs
Big vs. small or no problem…
• Getting OT, PT, Speech
– CSHCN 22% vs. 13%
n=480
OR 2.14
CI 1.17, 3.92
– Respondent is high school graduate
OR 2.99
CI 1.02, 8.67
• Getting referral to specialist
– CSHCN 14% vs. 9%
n=1,780
OR 1.73
CI 1.25, 2.39
– English not primary language
OR 1.77
CI 1.03, 3.03
• Delays in child’s care while waiting for plan
approval
– CSHCN 6% vs. 2%
n=5,390
OR 2.99
CI 2.15, 4.17
Multivariate analysis controlling for child and
respondent demographic factors.
Center for Children with Special Needs
17
• Got needed help or advice
sometimes/never vs. usually/always
when called doctor or nurse
– CSHCN 12% vs 10% n=4,534
OR 1.37
CI 1.12, 1.67
– Child ethnicity other than “white nonHispanic”
OR 1.33
CI 1.07, 1.65
– English not primary language
OR 2.18
CI 1.60, 2.97
Multivariate analysis controlling for child
and respondent demographic factors.
18
Center for Children with Special Needs
Customer Service
Big vs. small or no problem …
• Called or wrote plan with complaint or problem
– CSHCN 8% vs. 3% n=6,848
OR 2.78
CI 2.20, 3.52
• Getting help from customer service
– CSHCN 21% vs. 10%
n=1,168
OR 2.15
CI 1.52, 3.03
– Birth up to three years
OR .58
CI .34, .98
– English not primary language
OR .38
CI .15, .92
Multivariate analysis controlling for child and
respondent demographic factors.
19
Center for Children with Special Needs
• Finding or understanding written
information from plan
– CSHCN 11% vs. 7%
OR 1.73
n=1,360
CI 1.15, 2.60
• Problem with paperwork from plan
– CSHCN 16% vs. 9%
OR 1.88
n=1,422
CI 1.34, 2.63
– Birth up to three years
OR .5 CI .29, .87
– High school grad vs. not
OR .54
CI .33, .90
20
Center for Children with Special Needs
Most rate experiences with health plan high, but
respondents with CSHCN more likely to rate all
experiences from health plan lower.
120%
100%
80%
92%
0-5
(0=worst)
87%
60%
40%
20%
0%
13%
CSHCN
6-10
(10=best)
8%
N=6,817
OR 1.63
CI 1.38, 1.92
Not CSHCN
21
Center for Children with Special Needs
Guided by these
findings, health plans
can improve services for
CSHCN and families by
identifying procedures
within the plan that may
result in delayed care,
not getting care, and
how paperwork and
communication can
improve for families.
22
Center for Children with Special Needs
Contact Information:
Jacquie Stock, MPH
Research Associate
Center for Children with Special Needs
Children’s Hospital and Regional Medical Center
(206) 987-5327
[email protected]
Stacey DeFries, MSW
Assessment Coordinator
Children with Special Health Care Needs Program
Washington State Department of Health
(360) 236-3559
[email protected]
23
Center for Children with Special Needs