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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. Managed Care

Approach. Create or implement specifications within specialty managed care plans to capitate rates for CYSHCN.

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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):

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

  • Number of families of CYSHCN who have been notified about managed care plans with risk adjusted capitation rates.

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

  • Percent of families of CYSHCN who have been notified about managed care plans with risk adjusted capitation rates.

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

  • Number of CYSHCN enrolled in managed care plan with risk-adjusted capitation rates.

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

  • Percent of CYSHCN enrolled in managed care plan with risk-adjusted capitation rates.

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):

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


Reference:

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Managed Care Financing Strategy.

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.