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Incorporating the Six Core Elements of Health Care Transition Into a Medicaid Managed Care Plan: Lessons Learned From
Margaret McManus1, Patience White1, Robin Pirtle2
1The National Alliance to Advance Adolescent Health, #290, Washington, DC.
Insights
This pilot project improved health care transition services for young adults with complex conditions using the Six Core Elements framework. Managed care plans can enhance transition support by starting earlier and engaging more clinicians.
Area of Science:
- Health Services Research
- Pediatric to Adult Transition
- Managed Care
Background:
- Pediatric to adult health care transition is crucial for young adults with complex health needs.
- Effective transition requires structured programs and support within managed care settings.
- The Six Core Elements of Health Care Transition (2.0) provide a framework for improving these services.
Purpose of the Study:
- To describe the process and outcomes of integrating the Six Core Elements into a Medicaid managed care plan.
- To assess the effectiveness of customized transition services for young adults with chronic conditions.
- To identify areas for improvement in health care transition within managed care.
Main Methods:
- A pilot project involving 35 young adults (ages 18-23) with chronic mental health, developmental, and complex medical conditions.
- Implementation of the Six Core Elements of Health Care Transition (2.0) within a Medicaid managed care plan.
- Assessment of transition readiness, care plans, medical summaries, and transfer processes.
Main Results:
- The managed care plan advanced from level 1 to level 3 implementation of the Six Core Elements over 18 months.
- Key improvements included developing transition policies, readiness assessments, care plans, and transfer packages.
- Full implementation to level 4 was limited as elements were not yet plan-wide.
Conclusions:
- Customizing and delivering transition services using the Six Core Elements is effective in managed care.
- Earlier transition initiation (ages 12-14) and broader clinician involvement are recommended.
- Payment incentives for clinicians could further support the adoption of the Six Core Elements.
Abstract:
This pediatric-to-adult health care transition pilot project describes the process and results of incorporating the "Six Core Elements of Health Care Transition (2.0)" into a Medicaid managed care plan with a group of 35 18-23 year olds who have chronic mental health, developmental, and complex medical conditions. The pilot project demonstrated an effective approach for customizing and delivering recommended transition services. At the start of the 18-month project, the Medicaid plan was at the basic level (1) of transition implementation of the Six Core Elements with no transition policy, member transition readiness assessment results, health care transition plans of care, updated medical summaries, transfer package for the adult-focused provider, and assurance of transfer completion and consumer feedback. At the conclusion of the pilot project, the plan scored at level 3 on each core element. The primary reason for not scoring at the highest level (4) was because the transition elements have not been incorporated into services for all enrollees within the plan. Future efforts in managed care will benefit from starting the transition process much earlier (ages 12-14), expanding the role of nurse care managers and participating pediatric and adult-focused clinicians in transition, and offering payment incentives to clinicians to implement the Six Core Elements of Health Care Transition.
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