Transcript Coordinating Care for Young Children and Beyond: Early

Health Equity and Young
Children
State Context
May 30, 2013
BUILD Initiative Meeting
Carrie Hanlon, Program Manager
National Academy for State Health Policy (NASHP)
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NASHP
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Non-profit, non-partisan
Work with state agencies and branches of
state government to advance workable health
policy solutions
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Identify best practices
Disseminate lessons nationally
Guided by Academy Members
www.nashp.org
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Related Work
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Healthy child development
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Health equity/disparities
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Assuring Better Child Health and Development
(ABCD)
 25+ states (CO, MI, MN, OH)
Aetna Health Equity Learning Collaborative
 7 states (MN, OH)
AHRQ HCUP Race/Ethnicity Workgroup
 State collection and use of race/ethnicity data
Other (oral health, primary care transformation)
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Dual challenges
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Emphasis on immediate (health care)
savings—adults, chronically ill populations
Desire to simplify, “one size fits most”,
resistance to or lack of understanding about
importance of addressing inequities
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A Golden Opportunity
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Health care delivery reform—care teams,
accountable care initiatives
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Increasing focus on community partners/ linkages,
social determinants of health and population
health
A way to bring in partners with expertise in early
care/education, child health and health equity
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State Roles
 Purchase health care services
 Define benefits
 Regulate professionals and facilities
 Collect and report data
 Set standards and measure performance
 Inform consumers
 Educate and train healthcare professionals
 Convene stakeholders
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Medicaid, Medicaid, Medicaid,
(and CHIP)
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1 in 3 children under the age of 6 qualifies for
Medicaid (Urban Institute-UI)
Medicaid (and CHIP) covered over half of all
Hispanic and black children in 2010 (UI)
Compared to higher-income peers, children from
low-income families or on Medicaid
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Lag behind developmentally from as early as nine months
of age (Halle et al., 2009)
Experience Adverse Childhood Experiences at higher rate
(WI Children’s Trust Fund, 2010)
Have nearly twice the rate of untreated tooth decay (GAO,
2008)
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Regulatory, Purchasing
Strategies
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Set cultural and linguistic requirements for
managed care plans (CA)
Require health care providers to complete
cultural competence training (NJ)
Develop Medicaid managed care pediatric
performance improvement projects (IL, OR)
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Regulatory, Purchasing
Strategies, continued
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Provide Medicaid reimbursement for:
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Maternal depression screening (IL)
Care coordination (OR)
Preventive oral health services by mid-level dental
providers or PCPs
Screening for trauma or adverse childhood
experiences?
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Data and Measurement
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Create a standardized race/ethnicity data collection
policy (CT)
Inventory state agency collection of
race/ethnicity/language data (MN)
Establish Medicaid pay for performance incentive
measures:
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Developmental screening (OK)
Disparities reduction (MA)
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Delivery Reform Initiatives
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Overarching focus on children/equity:
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Children: RI Health Home SPA, CO medical homes
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Equity: OH medical homes, OR CCOs
Pediatric medical home qualification and
recertification standards
Pediatric learning collaboratives
Education for community-based programs (Head
Start, home visiting)
Child health and development data
Expectations for community partnerships,
linkages and engagement
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Cross-systems Strategies
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Educate policy makers about health equity (CT, MN)
Align education, early care, health care
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Tailored positions
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Cabinet-level child health director (OR)
Health equity? (OH Commission)
Shared goals/outcome measures
 Kindergarten readiness (OR)
Social determinants of health approaches
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Breathe Easy at Home (RI, Boston)
Medicaid outreach and enrollment using public health
data, GIS, spatial analysis (VA)
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Some Takeaways
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Optional vs. required, general vs. specific
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Who is at the table matters
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Include examples/expectations in guidance
State “template” with local flexibility
Cross-pollinate early learning, health equity, and
health reform councils
Convene pediatric advisory groups or include
pediatric providers in existing committees
Establish and leverage family-centeredness
and community partnership expectations
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Links
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NASHP website: www.nashp.org
Adverse Childhood Experiences in Wisconsin: Findings from the
2010 Behavioral Risk Factor Survey. (Wisconsin Children’s Trust
Fund) http://wichildrenstrustfund.org/files/WisconsinACEs.pdf
C. Coyer and G. Kenney, The Composition of Children Enrolled in
Medicaid and CHIP: Variation over Time and By Race and Ethnicity
(Urban Institute, 2013)
http://www.urban.org/publications/412783.html
T. Halle, et al., Disparities in Early Learning and Development:
Lessons from the Early Childhood Longitudinal Study—Birth Cohort
(The Council of Chief State School Officers and Child Trends, 2009).
U.S. Government Accountability Office, Extent of Dental Disease in
Children Has Not Decreased, and Millions are Estimated to Have
Untreated Tooth Decay (Washington, D.C.: GAO, 2008).
http://www.gao.gov/new.items/d081121.pdf
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