MCHbest. NPM 15: Continuous and Adequate Insurance
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.
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):
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):
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-. .