Electronic Information Exchange for Children in Foster Care.

Electronic Information Exchange
for Children in Foster Care
May 17, 2012
Beth Morrow
Director, Health IT Initiatives
The Children’s Partnership
Congressional Briefing -Improving Medicaid Mental Health
Services for Children
Children in foster care rely on Medicaid
for their health care
Medicaid is the health provider of first and last resort for
this population.
Over 70% of children entering foster care had Medicaid
coverage before placement.
The average cost of Medicaid per child in foster care is
over 3 times the average cost for nondisabled children.
Mental health issues are pervasive
and expensive in this population
Children in foster care account for 28% of all Medicaid expenditures
on inpatient psychiatric services (or, 46% of such expenditures on
nondisabled children).
 Nearly 70% of children in foster care exhibit moderate to severe
mental health problems and 40-60% are diagnosed with at least one
psychiatric disorder.
 Young adults leaving foster care face higher mental health problems
than the general population:
-- 50% will have at least one major mental health problem
-- 25 % have PTSD (compared to 4%)
-- 20% will have a major depressive episode (compared to 10%)
-- 8% face drug dependence (compared to 1%)
Coordinating care for this population
is a challenge
Children in foster care need a cross-system approach to
care, to ensure coordinated behavioral and medical
Communication needs to occur amongst the caregivers
that are responsible for their health and well-being:
caseworkers, foster parents, juvenile court judges,
teachers, and health professionals (physical, mental,
and dental), among others.
 Electronic Health Passports and other information
technology can help.
Building an electronic health record for
children in foster care: Examples
Wraparound Milwaukee
Operating since 1999. Serving about 1,000 children
Uses an internet-based electronic record system to
track, manage, and coordinate care for children at risk
of institutional placement (foster care and juvenile
Information included: contact information for primary
care physicians, dates of visits, eligibility information,
plan of care, crisis plan, progress notes, claims data,
and medications data.
Wraparound Milwaukee -Better Outcomes at Lower Cost
The average monthly cost to place a youth at a traditional Wisconsin
treatment center today is about $9,000. Wraparound is an alternative to
residential treatment, and costs $4,200 per month, per child.
Wraparound cites a drop in residential placements since its inception: from
375 youth placements (per day) in 1996 to 90 today.
Psychiatric hospitalization has declined from 5000 days to under 500 days
per year.
Child permanency has reached 85%; recidivism rates are low; and the
“child behavior” checklist records improvement compared to the national
In a recent quality improvement initiative (2007-2009) -- the number of
foster care clients with an identified primary care provider (PCP) rose from
60% to 94%. During the same time, among those with a PCP, usage of
three or more psychotropic medications dropped from 87% to 39%.
Other Examples:
Tennessee – Shared Community Health Record (since 2007)
 This effort is for all TennCare and Blue Cross/Blue Shield
enrollees, including 7,500 children in foster care.
 Have conducted a number of specific quality initiatives focused on
the foster care population – designed to ensure meaningful use of
the records by health providers and caseworkers.
 Results program-wide: Use of the electronic records resulted in an
18% cost avoidance driven by a reduction in pharmacy, ancillary
(lab, imaging, etc.), and facility (hospital charges, inpatient,
outpatient, etc.) costs.
-- The state believes this 18% cost avoidance applies to children in
foster care, as well.
Other Examples:
Texas – Health Passport (since 2008)
 Reported results:
• Reduction in the duplication of services.
• Improved care coordination and data sharing among a child’s
health care providers.
• Improved monitoring of compliance with prescription regimens.
• Enhanced preventive care through improved documentation of
Texas Health Steps exams.
• The Passport is available to the guardian as a child transitions out of
foster care and to the youth themselves, upon emancipation.
Other HIT tools can help improve
Medicaid mental health care, as well:
Online Screening – Improve Available Information
Such as UPMC for You (Allegheny County, PA), an online mental
health assessment tool used when children enter foster care and used
to initiate an EHR. Helps target services for the individual child and
identify service needs in the community.
Telehealth – Improve Access to Needed Care
Such as is being done by videoconference at Shasta Community
Health Center (Redding, CA), allowing remote visits with mental health
and other professionals where the services are otherwise unavailable
What we’re working on and why:
Ventura County Foster Health Link
Goal: Coordinate care and improve outcomes; Develop a model that
can be used to support better care for other populations of children,
such as all children in Medicaid.
-- Strong support/involvement by officials at state and county level.
-- Anticipate funding from HITECH and mixed county/private sources.
-- Coordinated with development of HIE in California.
-- Developing an electronic record that will begin with health and child
welfare information, then be expanded to include mental health,
education, and juvenile justice records.
-- Are planning for the system to include a youth-facing portal.
Congress should do its utmost to protect Medicaid and
its ability to deliver quality mental health services.
These services are essential to protect our nation’s
most vulnerable children.
Moving forward, stakeholders should improve the
effectiveness and enhance the outcomes of the
program by facilitating care coordination through
electronic information exchange.
Beth Morrow
(718) 832-6061
[email protected]
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