Issue Brief January 2018 Improving Chronic Care for Children in California: Learning from Medicare by Edward L. Schor, MD In October of this past year, the Senate passed the the family’s quality of life.1 The CHRONIC Act Creating High-Quality Results and Outcomes would provide shared savings incentive payments Necessary to Improve Chronic (CHRONIC) Care to medical teams that provide high quality home- Act of 2017. The legislation addresses the need to based care. Across California, child-serving improve chronic care for Medicare beneficiaries, hospitals have developed complex care clinics that primarily people could provide the backbone for expanded home- over age 65 and California’s transition of based services if they were adequately those under 65 children enrolled in CCS reimbursed.2 Medi-Cal and its managed care into Medi-Cal managed with permanent partners could take their lead from the Medicare health care plans is an disabilities. While experience and implement policies to improve opportunity to consider the Act targets home health care for children with medical systemic changes in the Medicare complexity. how chronic pediatric population, many of care is provided. its policies would Benefits Tailored to Populations: benefit children and youth with special In general, Medicaid requires that covered health care needs if they were adopted by state benefits are comparable for all enrollees. The Act Medicaid programs. would allow health plans serving Medicare beneficiaries to tailor coordination and benefits to Most of those policies can be put into effect by specific patient groups. Medi-Cal can similarly Medicaid through changes in state regulations or apply for a waiver that would allow health plans through submission of waiver applications to the serving children with special health care needs to Centers for Medicare & Medicaid Services. receive additional services beyond the core California’s transition of children enrolled in the benefits. Such services could include enhanced California Children’s Services program (CCS) care coordination and social and functional into Medi-Cal managed health care plans is an supports that would address personal and social opportunity to consider systemic changes in how barriers that prevent families from being able to chronic pediatric care is provided. take maximum advantage of available health care. Improved Home Health Care: Telehealth: A relatively small number of children and youth California is far behind in accessing the benefits require home health services, yet access to these of telehealth for pediatric chronic care services can greatly improve a child’s health and Improving Chronic Care for Children in California: Learning from Medicare Lucile Packard Foundation for Children’s Health www.lpfch.org/cshcn management.3 The CHRONIC Act would allow Americans, more than two-thirds of whom have health plans to include additional telehealth multiple chronic conditions. Medicaid was services in their contract applications, allow designed to serve a younger and generally patients to have virtual encounters with their healthier population, and the child-specific physicians from their homes, and in general benefits, outlined in the Early and Periodic, expand and increase the flexibility of the use of Screening, Diagnostic and Treatment program telehealth. Recommendations for similar (EPSDT), emphasize prevention and acute care. advancements specific to California have been Yet a substantial portion of children and made, but await action.4 adolescents have chronic conditions. The CCS program has enhanced chronic care for eligible Financial Incentives: children through case management and quality assurance procedures, but has not embraced the Prior to proposal of the CHRONIC Act, Medicare comprehensive approach exemplified by some adopted a number of other policies to improve Medicare policies. chronic care. These included giving providers a higher payment when they spend more time The transition of some CCS services from fee-for- actively coordinating care for chronically ill services reimbursement to managed health care patients, offering new payments to promote the offers the opportunity to expand services to integration of primary care and mental health children with chronic and complex health services, and incentivizing enhanced patient conditions. Advocates may want to encourage education and preventive care for patients at risk California’s policymakers to see Medicare for developing more chronic disabilities. Research policies, including those described above, as has demonstrated that each of these three services precedents to improve chronic care for children in -- care coordination, service integration, and California. patient education -- reduce costs and enhance quality of care. Edward L. Schor, MD, is senior vice president at the Lucile Packard Foundation for Children’s Medicare was designed for a population of older Health References 1. Elias ER, Murphy NA, and American Academy of Pediatrics Council on Children with Disabilities. Home care of children and youth with complex health care needs and technology dependencies. Pediatrics. 2012;129(5):996–1005. 2. Lobas JG. The Missing Piece: Medical homes for California’s children with medical complexity. Lucile Packard Foundation for Children’s Health. Palo Alto, September 2014 3. Vigil J, Kattlove J, Litman R, Marcin J, Calouro C, Kwong MW. Realizing the promise of telehealth for children with special health care needs. Lucile Packard Foundation for Children’s Health. Palo Alto, August 2015 4. Fact Sheet: Telehealth policy solutions for children with complex medical needs. Lucile Packard Foundation for Children’s Health. Palo Alto, August 2015 2 Improving Chronic Care for Children in California: Learning from Medicare Lucile Packard Foundation for Children’s Health www.lpfch.org/cshcn ABOUT THE FOUNDATION: The Lucile Packard Foundation for Children's Health is a public charity, founded in 1997. Its mission is to elevate the priority of children's health, and to increase the quality and accessibility of children's health care through leadership and direct investment. Through its Program for Children with Special Health Care Needs, the foundation supports development of a high-quality health care system that results in better health outcomes for children and enhanced quality of life for families. The Foundation encourages dissemination of its publications. A complete list of publications is available at http://www.lpfch.org/publications CONTACT: The Lucile Packard Foundation for Children’s Health, 400 Hamilton Avenue, Suite 340, Palo Alto, CA 94301 cshcn@lpfch.org (650) 497-8365 3 Improving Chronic Care for Children in California: Learning from Medicare