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Child/Adolescent Health

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A managed care model and care coordination can reduce emergency department use among children with special health care needs

A managed care model that emphasizes care coordination and does not include strong financial incentives to limit care use can reduce the use of emergency department (ED) care among children with special health care needs (CSHCN). CSHCN require not only disease-specific services, but also more costly care than other children do for common acute pediatric conditions, such as croup and fractures.

Researchers studied chronically ill children who were dually enrolled in Michigan's Title V program for CSHCN and Medicaid, and who were enrolled in a managed care option at some time during the study period. They compared ED use before and after the children joined the managed care plan.

Managed care enrollment was associated with a nearly one-fourth (23 percent) reduction in the incidence of ED use in this population. The authors observed no comparable reduction in ED use within the overall population of CSHCN who did not join the managed care plan.

Under the managed care program, each family selected a principal coordinating doctor and a local care coordinator, who worked with the family to develop an individualized health care plan. This medical home approach may have created an environment for the more effective management of chronic health problems and facilitated early intervention when those problems became acute, thereby reducing ED use.

Reduced ED use is a commonly cited indicator of improved access to more effective or more cost-effective care, note the authors. However, they caution that the study explores the impact of one Medicaid managed care program designed specifically for CSHCN.

The results may not generalize to other organizations and locations, especially rural locations with more limited available resources for care of CSHCN. The study was supported by the Agency for Healthcare Research and Quality (HS10441).

See "The impact of managed care enrollment on emergency department use among children with special health care needs," by Harold A. Pollack, Ph.D., John R.C. Wheeler, Ph.D., Anne Cowan, M.P.H., and Gary L. Freed, M.D., M.P.H., in the February 2007 Medical Care 45(2), pp. 139-145.

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