DOCUMENT RESUME PS 030 358 ED 464 735 From Coverage to Care in, Medicaid and CHIP: Getting Out the TITLE Preventive Care Message to Pennsylvania's Low-Income Families with Children. Philadelphia Citizens for Children and Youth, PA. INSTITUTION PUB DATE 2001-00-00 47p.; Project staff were Pat Redmond and Bettina Pearl. NOTE Project was funded by the Nathan Cummings Foundation and GlaxoSmithKline. Philadelphia Citizens for Children and Youth, 7 Benjamin AVAILABLE FROM Franklin Parkway, Philadelphia, PA 19103. Tel: 215-563-5848; Fax: 215-563-9442; e-mail: [email protected]. For full text: http://www.pccy.org/PDF/CoveragetoCare.pdf. PUB TYPE Reports Research (143) EDRS PRICE MF01/PCO2 Plus Postage. *Child Health; *Children; *Health Insurance; Low Income DESCRIPTORS Groups; *Outreach Programs; *Prevention; Program Descriptions Barriers to Participation; *Childrens Health Insurance IDENTIFIERS Program; *Medicaid; Pennsylvania ABSTRACT This report examines some of the ways a sample of Pennsylvania health care providers participating in Medicaid and the Children's Health Insurance Program (CHIP) strive to ensure that the children they serve make use of preventive health care. The report also identifies how managed care organizations or benefits administrators contracting with the state typically inform families about available benefits, assist them in using services, and interact on these issues with children's primary care providers. Information for the report was collected through interviews with personnel from 40 health care organizations. Responses indicated that a variety of preventive care outreach approaches are being used. Reminder calls and missed appointment notices were effective strategies used by most of the providers. Other more ambitious initiatives include welcome calls to all new CHIP members and a follow-up program to provide intensive education and support through home visits and referrals. Responses also indicated that compliance with required follow-up to families of children whose EPSDT screens are overdue is often difficult or impossible for many primary care providers. The amount of outreach and assistance provided by managed care organizations varied. Medicaid managed-care organizations report difficulty in locating families. A significant amount of outreach materials are produced only in English. The report includes recommendations intended to enhance the accomplishments of the organizations and to prompt the development of new best practices. Appended is an in-dePth examination of how a primary care provider and two CHIP organizations approach preventive care outreach, and a discussion of the issue of locating families who move frequently. (Contains 25 endnotes.) (KB) Reproductions supplied by EDRS are the best that can be made from the original document. Medicaid and CHIP: From Coverage to Care in Message to Getting Out the Preventive Care Children Pennsylvania& Low-Income Families with U.S. DEPARTMENT OF EDUCATION PERMISSION TO REPRODUCE AND Office of Educational Research and Improvement DISSEMINATE THIS MATERIAL HAS EDUCATIONAL RESOURCES INFORMATION BEEN GRANTED BY CENTER (ERIC) )(This document has been reproduced as received from the person or organization tfattri &Kb, Ch ter originating it. ID Minor changes have been made to improve reproduction quality. TO THE EDUCATIONAL RESOURCES ° Points of view or opinions stated in this INFORMATION CENTER (ERIC) document do not necessarily represent 1 official OERI position or policy. and Youth Philadelphia Citizens for Children 2001 2 AVAILABLE COPY BEST From Coverage to Care in Medicaid and CHIP: Getting Out the Preventive Care Message to Pennsylvania& Low-Income Families with Children A Report By Philadelphia Citizens for Children and Youth Seven Benjamin Franklin Parkway Philadelphia, Pa 19103 215-563-5848 www.pccy.org CO CY5 2001 Table of Contents From Coverage to Care in Medicaid and CHIP 7 Executive Summary 7 Introduction Getting Out the Preventative Care Message to through 7 Primary Care Providers Getting Out the Preventative Care Message to through 7 Managed Care Contractors 7 Conclusion 7 Recommendations Appendix Successful Strategies and Ongoing Concerns: The Community 7 Check Up Center of South Harrisburg 7 Welcome to CHIP: Two Examples of Preventative Care Outreach Locating CHIP and Medicaid Families: Different Challenges in 7 Different Systems 7 Credits From Coverage to Care in Medicaid and CHIP / Philadelphia Citizens for Children and Youth Page 1 4 Executive Summary 5 Executive Summary "Managed care has made us confront the real challenges in operationalizing the concept of a medical home. It is always much easier to treat the child in front of you than to develop effective Jonathan Finkelstein, M.D., M.P.H., outreach for those families who do not seek care." Harvard Medical School and Harvard Pilgrim Health Care This report examines some of the ways a sample of Pennsylvania health care providers participating in Medicaid and CHIP attempt to ensure that the children they It also identifies how managed care organizations or serve make use of preventive care. benefits administrators contracting with the state typically inform families about available benefits, assist them in using services, and interface on these issues with children's primary discussions care providers. The questions below which often surface in local and statewide of children's access to care prompted PCCY to survey Medicaid and CHIP primary care providers and managed care organizations about preventive care outreach. Once children are enrolled in health insurance, how do their parents learn about preventive care? How are children at risk of not receiving preventive care identified? What is currently done to reach out to and assist the families of children who do not get regular preventive care? What strategies are most effective for prompting families whose children might be missing out to use preventive care services? PCCY conducted interviews with 40 health care organizations, and found that Pennsylvania's Medicaid and CHIP programs can boast a variety of preventive care outreach efforts. Reminder calls and missed appointment notices, for example, are effective strategies used by most of the providers we surveyed. In addition, a number of providers and managed families with care organizations are embarked on more ambitious efforts to reach information about preventive care. Some of these initiatives, such as welcome calls to all Others, such new CHIP members, have been able to reach close to 80 percent of families. children as the EPSDT follow up program in one managed care organization, focus on who may be missing out on care and provide intensive education and support through home visits and referrals. The report also examines some outreach strategies that are inconsistently implemented among the organizations we surveyed, and points to some gaps in the ways that information is provided to families. For example, compliance with required follow up for to families of children whose EPSDT screens are overdue is often difficult or impossible many of the primary care providers we interviewed. Page 1 From Coverage to Care in Medicaid and CHIP / Philadelphia Citizens for Children and Youth Managed care organizations frequently take up this task, but the amount of outreach and the assistance they provide to families varies. Medicaid managed care organizations report difficulty in locating families due to frequent moves, and the procedures a family must follow to change an address seem to exacerbate this problem. Although some outreach materials are translated, a significant amount of material is still produced only in English, including key communications such as missed appointment notices. Recommendations developed from this research are intended to enhance the accomplishments of the organizations working with children enrolled in Medicaid and CHIP, and to prompt the development of new best practices. We were struck throughout this project by the complexity of designing preventive care outreach strategies to reach families who may have children enrolled in different coverage programs, may lack information about preventive care, and may have difficulty accessing care. As Pennsylvania's CHIP and Medicaid programs continue to reach more children in diverse communities, these challenges will grow. Our recommendations ask state government, primary care providers, and state Medicaid and CHIP contractors to ensure families have input into the design of outreach strategies; that primary care providers have the tools that they need to reach families; and that the initiatives from different parts of the health care system reinforce each other and make sense to families. The appendix to this report includes an in-depth look at how a primary care provider and two CHIP organizations approach preventive care outreach, and a discussion of the issue of locating families who move frequently. Page 1 From Coverage to Care in Medicaid and CHIP / Philadelphia Citizens for Children and Youth 7 Introduction 8 Introduction More Pennsylvania children than ever before are enrolled in Medicaid or the Children's Health Insurance Program (CHIP). These two programs, supported by federal and state funds, provide free or low-cost health coverage to 844,000 low to moderate-income Both programs provide a children, or 28 percent of the state's three million children.2 comprehensive benefits package, including primary and preventive care according to recommended schedules for children.' Each program also offers enrollment with no waiting lists to any children who qualify. This health coverage is invaluable to children in Pennsylvania. Study after study has shown that uninsured children often can't get the care they need, either to stay healthy life threatening. or to get early treatment for sickness, before it becomes serious or even Health coverage opens doors that are often closed to uninsured children: a Medicaid or CHIP card is the key not only to a doctor's office, but also to dental and vision care, prescription drugs, mental health care, and a range of other services.' To be fully effective, however, health coverage programs for children must design these services so that families will find them friendly and easy to use. Programs then need advantage of to inform parents and caretakers about the services, encouraging them to take all the health care that their children need. Because some low-income children have missed family income out on care in the past, and some may lose eligibility for coverage when their increases, it is especially important that they have every opportunity to receive care while they are enrolled in Medicaid and CHIP. No single characteristic distinguishes health care that meets the needs of low-income families with children, although such factors as culturally competent care, accessible practice hours, transportation and interpreter services, and seamless connections to other health and social services are recognized as important components in a family-friendly system.' by which we mean informing, encouraging, and assisting parents in using the Outreach health care system for their children, particularly primary and preventive carealso plays such as appointment reminders by an important role. In fact, some forms of outreach, telephone, are well documented as successful in prompting some families to get preventive care.' Survey Method To learn about the strategies used to reach out to families, PCCY conducted a telephone survey of 30 health care providers (some with multiple sites) whose practices included a significant percentage of children enrolled in Medicaid or CHIP. The survey employed, but also to understand was designed not only to determine what strategies are We also conducted telephone and the primary care provider's perspective on this issue. administrative entities contracting some in-person interviews with insurance companies and with Pennsylvania's Medicaid and CHIP programs, a total of 10 different organizations.' Page 1 From Coverage to Care in Medicaid and CHIP / Philadelphia Citizens for Children and Youth The surveys and interviews did not include questions on the adequacy of primary of care provider networks, practices offering weekend or evening office hours, availability consultation after hours, or many other characteristics of family-friendly health care. These tremendously important issues were beyond the scope of our research, but are key to understanding how well Pennsylvania's health care system serves low-income families. Outreach can inform and assist families; ultimately, the health care system must be designed to welcome and serve them. Survey Participants - Health Care Providers The 30 participating health care providers are hospital-based pediatric sites, federally qualified health centers, nurse-managed primary care sites and group practices serving a substantial number of children enrolled in Medicaid and/or CHIP. In most cases, we spoke with mid- or upper-level administrative staff, and/or pediatricians and nurse practitioners. The sites were chosen because they were accessible to PCCY staff through community. our established contacts with provider organizations and others in the health care The participating sites serve a wide range of populations, including a variety of racial and ethnic groups, and take various approaches to primary care for children. Nine of the participating organizations operate multiple sites, so that information from 56 sites is included in the report. A table displaying the sites by location is included in the appendix. Survey Participants - Managed Care and Administrative Organizations Six managed care organizations contract with the Commonwealth of Pennsylvania to provide care to people enrolled in Medicaid; six also contract with the Commonwealth to provide care to children enrolled in CHIP. Three of the CHIP contractors are also In two regions of the state, participation in managed care is Medicaid contractors. mandatory for people enrolled in Medicaid; a third region, the Lehigh/Capital area will require managed care for Medicaid enrollees as of April 2002 (enrollment for the mandatory enrolled in managed care, program begins in October 2001). Most children in CHIP are which includes a preferred provider organization in four counties in Central Pennsylvania. The Caring Foundation of Northeastern Pennsylvania provides dental and vision coverage to CHIP enrollees through an indemnity product; all other benefits are provided through managed care. For this report, we interviewed five of the six managed care organizations with Medicaid contracts; one managed care organization with both Medicaid and CHIP contracts declined to participate. We also interviewed the state's Medicaid primary care case management contractor; three CHIP administrative organizations and two managed care organizations with CHIP contracts. Page 1 From Coverage to Care in Medicaid and CHIP / Philadelphia Citizens for Children and Youth 1 0