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TRICARE Extended Care Health Option Program: Prevalence of pediatric ECHO enrollees and healthcare service
Nicole M Hsu1, Kyla Morris2, Amanda Banaag2
1Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Insights
This study examined pediatric beneficiaries in the Extended Care Health Option (ECHO) program, finding neurodevelopmental disorders were the most common diagnosis. Improving services for these military children is crucial for their development.
Area of Science:
- Pediatric Healthcare
- Military Health Systems
- Chronic Condition Management
Background:
- The Extended Care Health Option (ECHO) program supports Department of Defense (DoD) healthcare beneficiaries with chronic conditions.
- Limited data exists on military-connected children enrolled in the ECHO program.
Purpose of the Study:
- To analyze the demographic characteristics of pediatric ECHO beneficiaries.
- To evaluate the healthcare utilization patterns and claims data of this population.
Main Methods:
- A cross-sectional study analyzed TRICARE claims and Military Health System (MHS) encounter data from 2017-2019.
- Identified frequently reported ICD-10-CM and CPT codes for pediatric ECHO beneficiaries.
- Examined health service utilization within Military Treatment Facilities (MTFs) and the private sector.
Main Results:
- Over 21,500 pediatric individuals (1.1%) were enrolled in ECHO within the MHS.
- The majority of healthcare encounters (65.4%) occurred in MTFs.
- Neurodevelopmental disorders were the leading principal diagnoses, with outpatient visits comprising 94.8% of care.
Conclusions:
- The number of pediatric TRICARE beneficiaries eligible for ECHO is expected to increase.
- Enhanced services and support are necessary for military children with special healthcare needs to optimize developmental outcomes.
Background:
The Extended Care Health Option (ECHO) Program is a TRICARE program aimed at reducing the disabling effects of chronic medical conditions for beneficiaries of the Department of Defense (DoD) healthcare program. However, little is known about military-connected children enrolled in the program.
Objective/Hypothesis:
The aim of this study was to examine the demographic makeup of pediatric ECHO beneficiaries and their healthcare claims data. This is the first study to evaluate healthcare utilization of this subset of military dependents.
Methods:
A cross-sectional study was performed evaluating ECHO enrolled pediatric beneficiaries and their health service utilization during 2017-2019. TRICARE claims and military treatment facility (MTF) encounter data were utilized to evaluate health service utilization and identify the most frequently reported ICD-10-CM and CPT codes associated with care for this population.
Results:
Of the 2,001,619 dependents aged 0-26 years who received medical care in the Military Health System (MHS) during 2017-2019, 21,588 individuals (1.1%) were enrolled in ECHO. The majority of encounters (65.4%) were provided in the MTFs. Inpatient visits, therapeutic services, and in-home nursing care were the top utilized private sector care services. Outpatient visits encompassed 94.8% of healthcare encounters, and neurodevelopmental disorders were the top principal diagnoses among ECHO beneficiaries.
Conclusions:
With the increasing prevalence of children with medical complexity and developmental delay, the pediatric TRICARE beneficiaries eligible for ECHO will likely continue to rise. Improving services and supports for military children with special healthcare needs is needed to maximize their developmental trajectory.
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