With Medicaid and SCHIP enrollment of children in managed care on the rise,
7,8
Enhancing
Medicaid managed care organizations face a greater challenge to ensure delivery of
consistent and high quality child development services. The Commonwealth Fund
Child
asked the Center for Health Care Strategies (CHCS) to create a Best Clinical and
Development
Administrative Practices (BCAP) initiative to develop, document, and spread best
practices among health plans. This toolkit reflects the experiences of the BCAP
Services in
Workgroup on Enhancing Child Development Services in Medicaid Managed Care.
This workgroup (Table 1) of 10 health plans and one state primary care case man
Medicaid
agement program collaborated to develop, pilot, and refine best practices around
enhancing child development services.
Managed
Care
These 11 workgroup teams devoted time and resources to an area that does not
necessarily offer an immediate return on investment. We value their commitment
to improving care for populations in need and their resourcefulness in identifying
how to leverage opportunities to enhance child development services within their
organizations.
The Need to Enhance Child Development Services
Assessing young children's development at specified intervals makes it possible to
identify and treat developmental disabilities at the earliest stage and to help chil
dren lead active and healthy lives.
9
However, while approximately 15 to 18 percent
of children have disabilities such as speech language impairments, mental retarda
tion, learning disabilities, and emotional/behavioral disturbances, fewer than 30
percent of these children are identified with these problems prior to school
entrance. Though guidelines endorse routine developmental assessments for young
Online Toolkit
children, parents of many children do not report receiving these assessments.
10,11
Visit www.chcs.org for
Both parents and providers are dissatisfied with the current state of well child care
additional resources and
(Figure 1). Late and low identification of developmental problems in early
tools developed by the
Enhancing Child
Development Services in
Figure 1: The State of Well Child Care: A Snapshot
Medicaid Managed Care
workgroup.
Parents reporting important unmet
94
needs by pediatric clinicians
Pediatricians who agree they have sufficient
45
time to perform developmental assessments
Parents reporting they were not asked about
40
learning, development, or behavior concerns
U.S. children up to date with
vaccinations at end of first year of life
26.5
Pediatricians who agree they have sufficient
time to address family psychosocial problems
16.3
0 20 40 60 80 100
Percent
Source: Multiple studies, cited in E. Schor, Rethinking Well Child Care, Pediatrics 114 (July 2004).
7
The Centers for Medicare and Medicaid Services, Managed Care Trends, www.cms.hhs.gov/medicaid/managedcare/trends04.pdf.
8
V.K. Smith, D.M. Rousseau and M. O'Malley, SCHIP Program Enrollment December 2003 Update, July 2004, www.kff.org/medicaid/loader.cfm?url=/
commonspot/security/getfile.cfm&pageID=44443.
9
Halfon, et al., op. cit.
10
American Academy of Pediatrics, Committee on Children With Disabilities, Developmental Surveillance and Screening of Infants and Young Children,
Pediatrics 108, no. 1 (2001): 192 195.
11
M. Green and J.S. Palfrey, eds., Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents (2nd ed.,rev.), (Arlington, VA:
National Center for Education in Maternal and Child Health, 2002).
