When Compliance Is A Key To Good Pediatric Health

As a Massachusetts Medicaid (MassHealth) managed care health plan, Network Health serves an economically disadvantaged member base. Creating ways to get members to adhere to their medical regiments can be a real creative challenge.

But with a member base that is largely children, creating compliance incentives for parents is further challenging. Teaching pediatric members’ parents to understand and seek wellness care for their children is an important adjunct to the development of measurable intervention strategies -- all of which is used to maintain a safe and healthy pediatric population.

Case managers and quality teams are typically the first to recognize when pediatric benchmarks, which aim to identify and improve the health status of children by measuring developmental milestones, are not meeting the recommended adherence standards. Pediatric case managers are on the front lines with members and know which ones need help. They also know how to work with pediatricians to provide the support parents need to better understand the importance of wellness care.

When dealing with chronically non-compliant pediatric patients, the following may be helpful:

Question: What are incentive strategies and how do they improve wellness outcomes?

Answer: Incentive strategies are education-based tools offered to parents to help keep them on track with meeting their children’s scheduled and unscheduled pediatric health checks. These tools can be a creation of a child’s health plan, pediatrician, or community-based organization, and are principally used as vehicles to encourage parents to prevent childhood medical and developmental disorders by adhering to recommended wellness protocols. For some parents, certain incentive strategies can significantly improve their children’s adherence rates.

Question: At what age should a child be before introducing the parents to incentive strategies?

Answer: Because incentives do work to increase adherence rates, they are typically designed as a multi-year effort beginning at birth, which is when following immunization protocols can be packaged with other new baby educational materials for parents.

Question: What is a recommended approach for overseeing the management of childhood immunization schedules?

Answer: Having a three-pronged approach comprised of member education, member incentives, and provider site collaborations has been shown to work well with the pediatric population. Member education tools may include providing new parents with a reference guide to well baby visits, as well as guidelines for the first two years of life. Member incentives can be an interactive tracking system for recording immunizations for the first two years of life, which, when signed by the child’s pediatrician, can be exchanged for a gift certificate at a local toy store. Provider site collaborations offer the opportunity for pediatric case managers to identify the obstacles to and the opportunities for improving immunization rates.

Question: What other adherence tools can a health plan provide young patients who need further intervention as the result of early childhood development issues?

Answer: Further outreach and intervention is a fundamental necessity for certain under-served populations. For young children, this necessity may stem from a variety of possible baseline issues, such as unevenly delivered developmental screening services or lack of community resources.

At Network Health, for example, the social case management program provides licensed social workers, who, through home visits and phone contact, help identify the social barriers that may contribute to a child’s need for further health care intervention and screenings, and/or additional referrals to services within the community. Social case managers also ensure that provider office visits are arranged and obstacles for getting to appointments are addressed. For example, if a young parent’s chronic problem with keeping immunization appointments can be corrected with a simple reminder call from the case manager the morning of the scheduled appointment, the patient’s no-shows are likely to be reduced. This is a win-win situation for the child and the provider. On occasion, home health nurses who treat a child in the home can offer providers an additional set of eyes and ears for measuring the child’s potential developmental delays. Timely office visits can be more productive once home visit intervention takes place.

Question: Besides case management, are there other services tailored for child specific, non-compliance interventions?

Answer: Through a health plan’s maternal-child health program, case managers help educate and assist new moms with breast-feeding and with using breast pumps. In addition, these case managers work to address many of the fears and concerns commonly affecting new moms and their newborns, and when needed, may refer them to the appropriate community support service organization.

Peggy Waters is the manager for maternal child health at Network Health, which a comprehensive Medicaid health plan serving Massachusetts. Waters is responsible for leading the plan’s efforts in maternal child health case management systems and operational policy, and providing case management assistance to plan members and providers. She is currently leading Enhancing Early Child Development Services in Medicaid Managed Care, which is a Best Clinical and Administrative Practices pilot project initiative of the Center for Health Care Strategies. For more information, e-mail peggy.waters@network-health.org.

If you have any questions for a Pediatricians, contact one of our New York Pediatricians today.

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