MCHbest. NPM 15: Continuous and Adequate Insurance
Strategy. Managed Care
Approach. Create or implement specifications within specialty managed care plans to capitate rates for CYSHCN.
Overview. Some states have implemented specifications within their managed care contracts or created specialty managed care plans for children and youth with special health care needs (CYSHCN). In most of these plans, special (risk adjusted) capitation rates are set, reflecting the higher costs associated with meeting the health care needs of CYSHCN.1
Evidence. Expert Opinion/Field Generated. 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. Systems.
Outcome. Percent of children, ages 0 through 17, who are continuously and adequately insured. 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 across all states/jurisdictions 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 “Create or implement specifications within specialty managed care plans to capitate rates for CYSHCN,” 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):
Notes. 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):
1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Managed Care Financing Strategy.