A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.

[1]  E. Schulte,et al.  Pediatrician Guidance in Supporting Families of Children Who Are Adopted, Fostered, or in Kinship Care , 2020, Pediatrics.

[2]  H. MacMillan,et al.  Children Exposed to Maltreatment: Assessment and the Role of Psychotropic Medication , 2020, Pediatrics.

[3]  M. Mitra,et al.  Impact of Medical Home on Health Care of Children With and Without Special Health Care Needs: Update from the 2016 National Survey of Children’s Health , 2019, Maternal and Child Health Journal.

[4]  L. Hulvershorn,et al.  Within-Subject Change in Psychotropic Prescribing Patterns Among Youth in Foster Care Associated With a Peer-to-Peer Physician Consultation Program. , 2019, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  M. Tibbits,et al.  Money, Managed Care, and Medicaid Initiatives Matter: Patient-centered Medical Home Capacity in School-based Health Centers , 2019, Journal of health care for the poor and underserved.

[6]  C. Zeanah,et al.  Effective mental health treatment for children in foster care. , 2019, The Lancet. Child & adolescent health.

[7]  D. Cook,et al.  An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability : an observational study using a primary care database , 2017 .

[8]  Christopher Wildeman,et al.  Mental and Physical Health of Children in Foster Care , 2016, Pediatrics.

[9]  Cori M. Green,et al.  Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems? , 2016, Academic pediatrics.

[10]  J. Nackashi.  Medical Home Initiatives for Children With Special Needs Project Advisory Committee , 2016, Pediatric Clinical Practice Guidelines & Policies.

[11]  Gregory D. Stevens,et al.  National Trends in Indicators of a Medical Home for Children , 2016, Maternal and Child Health Journal.

[12]  B. Green,et al.  Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training , 2016, Journal of loss & trauma.

[13]  Sarah R Zlotnik,et al.  Health Care Issues for Children and Adolescents in Foster Care and Kinship Care , 2015, Pediatrics.

[14]  K. Fortin,et al.  Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care. , 2015, Current problems in pediatric and adolescent health care.

[15]  J. Zupancic,et al.  Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness: a randomized clinical trial. , 2014, JAMA.

[16]  R. Raghavan,et al.  Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States. , 2014, Psychiatric services.

[17]  Chris Feudtner,et al.  Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation , 2014, BMC Pediatrics.

[18]  T. Freund,et al.  Strategies for Reducing Potentially Avoidable Hospitalizations for Ambulatory Care–Sensitive Conditions , 2013, The Annals of Family Medicine.

[19]  A. Zaslavsky,et al.  Quality and Equity of Primary Care With Patient-Centered Medical Homes: Results From a National Survey , 2013, Medical care.

[20]  Jeffrey A. Alexander,et al.  Patient-physician role relationships and patient activation among individuals with chronic illness. , 2012, Health services research.

[21]  Denise Thomson,et al.  Standard 6: Age Groups for Pediatric Trials , 2012, Pediatrics.

[22]  D. Grossman,et al.  Medical home access and health care use and expenditures among children with special health care needs. , 2012, Archives of pediatrics & adolescent medicine.

[23]  H. Bauchner,et al.  The Value of the Medical Home for Children Without Special Health Care Needs , 2012, Pediatrics.

[24]  L. DeRigne,et al.  Medical Home and Out-of-Pocket Medical Costs for Children With Special Health Care Needs , 2011, Pediatrics.

[25]  Elizabeth A Stuart,et al.  Propensity score techniques and the assessment of measured covariate balance to test causal associations in psychological research. , 2010, Psychological methods.

[26]  D. Sullivan,et al.  The well-being of children in foster care: Exploring physical and mental health needs , 2008 .

[27]  Geier Gr,et al.  Medical Home. , 2021, The New England journal of medicine.

[28]  S. Graham-Bermann,et al.  Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children. , 2005, The Journal of pediatrics.

[29]  R. Hansen,et al.  Comparing the health status of low-income children in and out of foster care. , 2004, Child welfare.

[30]  T. Tonniges,et al.  History of the medical home concept. , 2004, Pediatrics.

[31]  L. Leslie,et al.  Children in foster care: factors influencing outpatient mental health service use. , 2000, Child abuse & neglect.

[32]  Mph Simran Chaudhri MD,et al.  Trauma-Informed Care: a Strategy to Improve Primary Healthcare Engagement for Persons with Criminal Justice System Involvement , 2019, Journal of General Internal Medicine.

[33]  A. Hildenbrand,et al.  Implementing a Trauma-Informed Approach in Pediatric Health Care Networks. , 2016, JAMA pediatrics.

[34]  B. Green,et al.  Trauma-informed medical care: CME communication training for primary care providers. , 2015, Family medicine.

[35]  George S. Ake,et al.  Complex trauma and mental health in children and adolescents placed in foster care: findings from the National Child Traumatic Stress Network. , 2011, Child welfare.

[36]  G. Margolin,et al.  The effects of family and community violence on children. , 2000, Annual review of psychology.