Evidence Tools
MCHbest. Medical Home: Personal Doctor or Nurse.

Overview. Systems like Medicaid Managed Care can increase access and quality of care with the use of a network of healthcare providers available to children and their families. For children, access to a primary care provider. (PCP) is associated with decreases in avoidable inpatient admissions, more appropriate use of specialists, increased opportunities to conduct screenings and risk assessments, and reduced emergency department. (ED) visits. In comparison, the fee-for-service. (FFS) structure is more flexible but also provides lower provider reimbursement, which may lead to difficulty establishing a PCP, poor continuity of care, and poor communication across providers. There is preliminary evidence that youth who transition to managed care may have greater access to primary care and fewer ED visits than youth in an FFS system for children and youth who need additional support, such as those in foster care.[1] Evidence shows that transitioning to systems like Medicaid Managed Care may enable more children from low-income backgrounds to have the opportunity to establish and maintain relationships with care providers.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

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

• Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
• Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare 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. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models 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).