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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. 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

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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 Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Care coordination service logs and client records
  • Provider and family satisfaction data
  • Care coordinator documentation of case-related challenges to care

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Case Management (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of care coordinators hired and trained to serve children with chronic diseases. (Measures workforce capacity to deliver the intervention)
  • Number of comprehensive needs assessments completed by care coordinators for enrolled children. (Quantifies foundational step in tailoring services)

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

  • Percent of care coordinators who meet defined competency standards for serving children with chronic diseases. (Evaluates workforce readiness)
  • Percent of care coordination encounters that meet quality criteria for family engagement. (Assesses experience of care)

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

  • Number of hours spent by care coordinators on promotion with insurers and service providers. (Quantifies effort to ensure coverage, access, and quality)
  • Number of community resource guides developed and disseminated by care coordinators. (Supports family awareness of and connections to local assets)
  • Number of emergency department visits and hospitalizations avoided through early intervention by care coordinators. (Demonstrates prevention of acute exacerbations)
  • Number of families referred to respite care and support groups by care coordinators. (Measures attention to caregiver strain and coping)

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

  • Percent of children with a chronic disease in the community who are enrolled in care coordination. (Measures population penetration)
  • Percent of care coordinators who participate in regular training on benefits, coverage, and costs. (Ensures capacity to optimize insurance adequacy)
  • Percent reduction in out-of-pocket costs for families of children with chronic diseases. (Demonstrates concrete financial impact of ensuring benefits access)
  • Percent of children whose care plans are implemented as intended, based on family report and service logs. (Shows fidelity to planned interventions)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 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.