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An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort
Jessie L Juusola1, Shefali Kumar1, Meghana S Iragavarapu1
1Anchor Outcomes LLC, 1933 California Street, San Francisco, CA, 94109, United States.
Insights
This study shows a new Enhanced Care Management (ECM) program effectively engaged high-need pediatric Medicaid patients. The program improved healthcare engagement and reduced depressive symptoms, demonstrating its potential for better pediatric health outcomes.
Area of Science:
- Pediatric Health Outcomes
- Healthcare Management
- Medicaid Services
Background:
- California Advancing and Innovating Medi-Cal (CalAIM) supports Enhanced Care Management (ECM) for high-need children.
- Published evidence on ECM's impact in pediatric populations is limited.
Purpose of the Study:
- Evaluate a novel multidisciplinary care model (Pair Team) for delivering ECM services.
- Assess implementation and early outcomes for children and adolescents in California's Medicaid program.
Main Methods:
- Retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents (July 2022 - Nov 2024).
- Assessed program engagement, healthcare engagement, and depressive symptoms using program data, EHRs, and prescription data.
Main Results:
- 1294 enrollees with 12 months follow-up; mean age 8.9 years; 81.8% experienced homelessness.
- Average 2.8 interactions/month with care team; 57.1% enrollment retention at 12 months.
- Post-enrollment: increased outpatient visits (7%), decreased ED visits (9%), increased asthma diagnosis (7.8% to 10.0%), and improved PHQ-9 scores for depression.
Conclusions:
- An innovative ECM program successfully engaged and retained high-need pediatric Medicaid patients.
- Program members showed improved healthcare engagement and reduced depressive symptoms.
- This model shows potential for improving outcomes in high-need pediatric Medicaid populations.
Background:
The California Advancing and Innovating Medi-Cal (CalAIM) initiative supports Enhanced Care Management (ECM) for high-need pediatric populations but published evidence of the impact of ECM in pediatric populations is lacking.
Objective:
We evaluated a novel multidisciplinary care model (Pair Team) for delivering ECM services, focusing on implementation and early outcomes for children and adolescents enrolled in California's Medicaid program (Medi-Cal).
Methods:
We conducted a retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents who enrolled in Pair Team's program between July 2022 and November 2024. Program engagement, health care engagement, and depressive symptoms were assessed using program data, electronic health records, and prescription data.
Results:
The main cohort included 1294 enrollees with 12 months of follow-up data (mean age 8.9 years, 50.3% (651/1294) female, 81.8% (1058/1294) experiencing homelessness). Members averaged 2.8 interactions per month with care team members over the first 3 months and 57.1% (851/1491) were still enrolled at 12 months. In the year prior to enrollment compared to the year postenrollment, the prevalence of an asthma diagnosis increased from 7.8% to 10.0% (P=.005), outpatient visits increased 7% (rate ratio, RR=1.07, P<.001), emergency department visits decreased 9% (RR=0.91, P=.002), and antibiotic prescriptions increased 41% (RR=1.41, P=.001). For those with depressive symptoms at enrollment, mean PHQ-9 score decreased from 15.4 (SD 4.7) to 10.2 (SD 6.8) after 3 months (P<.001).
Conclusions:
An innovative ECM program successfully engaged with and retained high-need pediatric Medicaid patients. Program members had higher engagement with other health care in the year following enrollment, and depressive symptoms improved. These results highlight the potential for this model to improve outcomes for the highest-need pediatric Medicaid patients.
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