Health Care Plans
Washington State Health Care Plans
National Resources for Insurers/ Health Care Plans
Washington State Health Care Plans
A number of health care plans in Washington State have developed programs to better address the needs of their member who are children with special health care needs.
Community Health Plan of Washington (CHPW)
Description of care coordination and other services for children with special health care needs enrolled in CHPW. Includes links to assessment and care plan tools used by CHPW.
www.chpw.org/en/provider/caremgmt/case-children.php
Molina Healthcare of Washington www.molinahealthcare.com
Eighty percent of Molina's population is under 18. Using the FACCT (Foundation for Accountability Tool), Molina Healthcare has identified approximately 13% of the children they cover as having special health care needs. The most common diagnosis in this population is asthma, followed by Attention Deficit Hyperactivity Disorder (ADHD). Children with special needs who have been identified by their families, primary care providers, or health plan data as potentially being particularly able to benefit from help with care coordination receive extra help from Molina. Health educators employed by the plan will call these families and talk with them to see if their needs are being met and how to help them (see Children with Special Healthcare Needs Screening form).
Molina Healthcare is working toward improving care and service for these Children with Special Healthcare Needs (CSHCN). Their Children with Special Health Care Needs Program is designed to assist families with coordination of care and to provide information regarding available resources.
CSHCN Program services:
- Molina Healthcare worked with primary care providers to develop a Medical Home documentation tool. This tool is used to list all care providers and ancillary caregivers involved in the often complex care needed. (see Medical Home Tool)
- Health management programs specific to pediatric asthma and diabetes
- Hospital follow-up for children with seizures – Molina Healthcare has a hospital follow-up program for children with special health care needs. RN Care Managers from Molina Healthcare call the primary caregiver of children, ages two to 18, hospitalized for seizure disorders. The RN Care Manager completes an assessment of the patient’s medical needs and works with the PCP to resolve concerns. A copy of the assessment is then faxed to the PCP’s office.
- Tracking system – Molina Healthcare has a tracking system to assist RN Care Managers in coordinating resources for special needs children by accessing the Title V program and SSI (when appropriate). The RN Care Manager will also work with the primary health care provider (PCP) to ensure the needs of the patient are met and a care plan is developed with the PCP. (see Care Plan Template)
- Attention Deficit Hyperactivity Disorder (ADHD) Newsletter and handbook – Proper education can help parents and children meet the challenges of living with ADHD. Molina Healthcare distributes an ADHD newsletter and handbook to ADHD Members.
- Clinical Practice Guidelines – Molina Healthcare adopted the American Academy of Pediatrics “Clinical Practice Guidelines: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder.”
- Camp opportunities for children with special health care needs – Molina Healthcare awards CSHCN camp scholarships to children selected from nominations made by PCPs.
Regence Blue Shield
Children with Special Health Care Needs website page for members.
www.wa.regence.com/member/health/specialNeeds.html
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National Resources for Insurers/ Health Care Plans
New Toolkit on Enhancing Child Development Services in Medicaid Managed Care
Enhancing Child Development Services in Medicaid Managed Care, a new toolkit from the Center for Health Care Strategies (CHCS), offers practical strategies to help health plans and states identify and treat developmental delays in children, age 0 to 3, at the earliest stage possible. The toolkit is based on the experiences of 10 health plans and one primary care case management organization that participated in a Best Clinical and Administrative Practices (BCAP) workgroup, which was made possible by The Commonwealth Fund. Strategies outlined in the toolkit include increasing the use of standardized developmental screening tools, improving outreach to members, enhancing provider partnerships, and linking reimbursement to developmental screening. Case studies illustrate how plans applied the BCAP Quality Framework to improve child development services in Medicaid managed care.
Visit www.chcs.org to download the toolkit or request a free print copy. The website also includes practical tools for organizations interested in designing programs to improve child development services.
Center for Health Care Strategies
The Center funds many learning collaboratives adn other research to help health care plans and state agencies improve services for children receiving services through Medicaid and for people with disabilities and chronic conditions. The website has practical toolkits and reports on lessons learned from their different initiatives.
- Main website: www.chcs.org
- Washington State activities: www.chcs.org, then go to "Advanced Search" option on left menu and select Washington.
National Center of Medical Home Initiatives for Children with Special Needs – Tools for Insurers
Resources include:
- CYSHCN: Data
- Benefits of Medical Home
- Focusing in on the Workplace
- Guides and Toolkits
- Model Programs
www.medicalhomeinfo.org/tools/Insurers.html
Suggestions for more plans/links to add? Please send them to us! info@medicalhome.org
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