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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Care Coordination

Approach. Provide access to comprehensive care coordination for children with chronic diseases to ensure benefits adequacy and reasonable costs through community health workers.

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Overview. Care coordination as a Medicaid add-on benefit supports adequate insurance coverage for children with chronic health conditions by ensuring access to health care and social support services and reducing out-of-pocket costs.1 Care coordination can be delivered by community health workers who assess individual and family needs as well as patterns of utilization to determine specific services offered to each family and ensure benefits adequacy for children with chronic diseases.2

Evidence. Emerging. Initial research showed positive results for this strategy, but further research is needed to confirm effects. This strategy has been tested more than once and results trend positive overall. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings). The Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN) has identified this strategy as an innovative strategy. Read more in their practice report.

Target Audience. State/Community; systems that treat CYSHCN.

Outcome.  Reduce out-of-pocket costs and enhance benefits adequacy for children and families. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Provide access to comprehensive care coordination for children with chronic diseases to ensure benefits adequacy and reasonable costs through community health workers,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of community-health workers trained to provide care coordination services to publicly-insured children with chronic diseases.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of children receiving comprehensive care coordination as a result of the Medicaid benefit.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of families with improved access to health care and social support services. 
  • Number of families reporting reasonable out-of-pocket costs.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of families who reporting improvements in their children’s health and well-being.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 https://ciswh.org/project/the-catalyst-center/financing-strategy/care-coordination

2 Caskey, R, Moran K, Touchette D, Martin M, Munoz G, Kanabar P, Van Voorhees B. Effect of comprehensive care coordination on Medicaid expenditures compared with usual care among children and youth with chronic disease: a randomized clinical trial. JAMA network open. 2019 Oct 2;2(10):e1912604-. .

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.