An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort...

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.