Improving Medicaid services for children
Improving Medicaid services for children
Too many children enrolled in Medicaid don't receive the comprehensive developmental assessments that states are required to provide through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. As a result, according to researchers at Mathematica Policy Research and George Washington University, many developmental problems remain unidentified or go untreated.
States are required to assess the quality of care for Medicaid beneficiaries in managed care plans. A few states have decided to look at the quality of preventive and developmental services for children in Medicaid.
The researchers say policy-makers, program administrators, foundations, providers, and consumer groups concerned with child health services should especially be interested in strategies states have used or could use to assess and improve services for children. Children are the single largest group of Medicaid beneficiaries, and states can contribute substantially to improving their health outcomes by ensuring the quality of required preventive and developmental services.
A March 2003 federal regulation obligated states to assess the quality of care for Medicaid beneficiaries enrolled in managed care plans. Many states have contracted with external quality review organizations (EQRO) to assist in that process. The regulation requires states to: 1) develop and implement a written quality assessment and improvement strategy; 2) adopt standardized methods for quality review activities, and 3) conduct annual independent reviews of quality outcomes.
The quality review framework established by federal regulations gives managed care organizations primary responsibility for conducting quality review activities. It gives EQROs an oversight and consultation role. The researchers say states need to ensure they include appropriate provisions in contracts with managed care organizations and EQROs. Quality-related specifications for an EQRO's scope of work include:
1. determining managed care organization compliance with federal managed care regulations related to EPSDT;
2. measuring performance of a managed care organization relative to ensuring delivery of children's preventive and developmental services;
3. recommending and subsequently evaluating a performance improvement project for implementation by the state's managed care organizations to improve the quality of preventive and developmental services;
4. assessing a managed care organization's information system related to preventive and developmental services;
5. conducting a focused study related to children's preventive and developmental services.
Implementing an appropriate scope of work for EQROs is only one step in building a sustainable commitment to improving preventive and developmental services for children in Medicaid, the researchers say. As state staff integrate child health outcomes into an overall quality improvement strategy and align their requests for proposals and EQRO contracts to support such a strategy, they can begin to put in place other processes that will contribute to a long-term commitment to enhancing preventive and developmental services.
North Carolina, Vermont, and Washington State have successfully collaborated with providers to help improve children's preventive and developmental services. The authors say that one way states can replicate such success is by including in their contracts a requirement that managed care organizations and EQROs participate in a collaborative project with providers. States must involve providers in the policy-making process, they say, and also must plan for use of electronic medical records.
They say that continued growth in electronic medical records systems presents important opportunities for state agencies to improve standards for providing and documenting preventive and developmental services. Through cues embedded in standard screens, data fields, and automatic reminders, electronic medical records can help improve the quality of services children receive. To improve delivery of such services, pediatric practices can use electronic medical records for decision support, such as deficiency alerts for immunizations or prompts for preventive services, or for links to specific screening questions or anticipatory scripts and handouts.
Studies, the authors assert, have indicated an association between using an electronic medical record system in a pediatric practice and improved quality of care, especially for delivering preventive services. One study found that pediatric primary care delivered in a practice using electronic medical records was better than delivered in practices not using electronic records in every area evaluated, including health history, risk assessment, developmental screening, and anticipatory guidance.
"An enduring commitment to children's health means that states must implement an appropriate scope of work that will provide EQROs with the necessary direction to conduct quality improvement activities, involve providers in the policy-making process, and plan for use of electronic medical records," the researchers conclude. In a continually evolving regulatory environment, states often focus on meeting requirements and operating within budget constraints. Regardless of the regulatory climate, however, states have many compelling reasons for making long-term commitments to improving the quality of preventive and developmental services for young children enrolled in Medicaid. These services promote healthy development throughout a child's life and reduce the onset of serious physical and behavioral problems. Creating the infrastructure to monitor and assess the quality of preventive and developmental care can have a lasting impact on the health of children and their families, and thus on society as a whole."
Download information at www.commonwealthfund.org/publications/ publications_show.htm?doc_id=691557.
Too many children enrolled in Medicaid don't receive the comprehensive developmental assessments that states are required to provide through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. As a result, according to researchers at Mathematica Policy Research and George Washington University, many developmental problems remain unidentified or go untreated.Subscribe Now for Access
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