By Ellen Albritton (Academy Health) and the national evaluation team from AcademyHealth, Mathematica Policy Research, The Urban Institute, and The Agency for Healthcare Research and Quality
The Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Program funded grants that supported efforts in 18 states to identify effective, replicable strategies for enhancing quality of care for children. Together, the grant program and its evaluation are among the nation's largest and most important efforts to improve the quality of health care for children enrolled in Medicaid and CHIP. Several states in the demonstration have been implementing projects to improve care for CYSHCN, including supporting practices in enhancing care coordination and improving caregiver peer support programs.
Care coordination is a key component of high-quality care for CSHCN, but many practices struggle to find the resources to perform care coordination functions. Six CHIPRA quality demonstration states supported child-serving primary care practices in improving these functions, providing an opportunity to identify effective strategies for enhancing and sustaining care coordination.
These states took different approaches: Idaho, Utah and West Virginia used grant funds to hire care coordinators embedded in practices; Alaska and Oregon educated practices about the functions of care coordination; and Massachusetts deployed care coordinators from an existing state program to improve practice care coordination capacity. Practices reported that care coordinators improved the quality of care by improving patient centeredness, population management, provider efficiency and capacity, and caregiver satisfaction. These improvements led many practices to hire or commit to hiring care coordinators using practice resources.
States reported that effective strategies for supporting care coordination are tailored to the particular needs, circumstances, and readiness of practices, and practice staff need to value and understand the contributions of care coordinators. To this end, states held learning sessions and shared information to help practices explore the functions, roles, and benefits of care coordinators. To learn more about these state efforts, see Evaluation Highlight # 9.
For caregivers of CYSHCN, receiving support from other caregivers of CYSHCN who have learned how to navigate health and social service systems can reduce their stress and improve their ability to care for their children. Four CHIPRA quality demonstration states are using grant funds to expand and improve caregiver peer support programs, and the lessons learned can be helpful to other states and practices looking to implement similar efforts.
In Maryland and Georgia the state recruited and trained caregivers of children with complex behavioral health care needs to work full time providing peer support through a variety of behavioral health organizations for children. These services are currently reimbursable through Medicaid in each state. In contrast, primary care practices in Idaho and Utah took the lead in partnering with parents of CYSHCN to provide peer support to other caregivers of CYSHCN in the practice and to advise the practice on quality improvement strategies. These "parent partners" worked part-time and received a small grant-supported stipend.
Because of concerns about privacy, liability, and the accuracy of information provided during peer support sessions, all four states worked closely with providers to ensure successful implementation of peer support programs. States addressed provider concerns by informing providers of caregiver training requirements, creating opportunities for practices to learn from other practices using peer support, and holding "get to know you" events for providers and peer support caregivers. States found that providing training and emotional support to caregivers who provide peer support also was key because these caregivers may experience medical emergencies or other stressors in their own family. To learn more, see Evaluation Highlight #7.
You can find descriptions of the demonstration projects, other findings, implementation guides, and state reports from the national evaluation website: http://www.ahrq.gov/chipra/ demoeval/. To stay informed of future findings from the national evaluation, subscribe to e-mail updates. Contact CHIPRADemoEval@ahrw.hhs.gov with any questions.