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Providing High-Quality Services to Children with Special Health Care Needs (CSHCN) Under Managed Care
Fully-Capitated Managed Care Arrangements
Serving Children with Special Health Care Needs
Donald Blanchon, M.P.H., M.P.A., Vice President for Strategic Planning, Health Services for Children with Special Needs, Inc., Washington, D.C.
Wendy Long, M.D., M.P.H., Medical Director, TennCare, Nashville, TN.
Ron Uken, M.S.W., Independent Consultant, Okemos, MI.
An alternative approach to serving CSHCN under managed care is for States to provide care for
this population through fully-capitated managed care plans. This can be accomplished in one of
- By enrolling CSHCN in the same managed care plans as the general population of children.
- By developing distinct and specialized managed care systems to serve the population separately.
In this session, the panelists discussed the critical design issues to be addressed under either of
these options to ensure the delivery of high-quality care.
Don Blanchon of Health Services for
Children with Special Needs, Inc., discussed a managed care plan developed exclusively for
children eligible for Supplemental Security Income (SSI) that is being used by the District of Columbia under a federal research
and demonstration project. Some of the key features of this plan include:
- Extensive outreach to eligible families.
- Voluntary enrollment.
- Coordination of care.
- An open panel model.
According to Mr. Blanchon, the continuing challenges for this plan are educating families and
providers about managed care and establishing formal relationships with public and private
agencies that serve children.
Wendy Long, Medical Director of TennCare, provided an example of how Tennessee enrolled
CSHCN along with other children in TennCare's fully capitated system. Although special
training was provided to Managed Care Organizations (MCOs) staff, there were still a number of implementation challenges,
including difficulties determining medical necessity and access standards for specialty services,
and slow acceptance of a greater quality assurance role on the part of Title V CSHCN program
staff. Initial analyses of quality monitoring results indicate that TennCare is saving money while
increasing rates of insurance coverage in Tennessee.
In order to serve CSHCN in the State of Michigan, according to Ron Uken, the former Chief
of Michigan Children's Special Health Care Services, the objective is to enter into long-term
contracted partnerships with a limited number of MCOs in order to develop specialized, high-quality delivery systems, while sharing financial risk. The State has issued an Request for Proposals (RFP) for a
proposed system that will feature voluntary enrollment and family-centered care coordination in
a variety of delivery settings including offices, schools and hospitals. The State CSHCN program
will be also acquiring new oversight responsibilities, such as quality assurance, contract
management and organizing and training staff.
State of Michigan, Department of Management and Budget (DMB), Request for Proposal. Children's Specialty and Children's Comprehensive Health Care.
Pages i-xi, 17-103.
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