Incentivizing Care Coordination in Managed Care.

Abstract

* Abbreviations: CMC — : children with medical complexity CSHCN — : children with special health care needs HMO — : health maintenance organization NSCH — : National Survey of Children’s Health PCCM — : primary care case management Care coordination for children remains one of the least-understood, widespread practice and policy interventions in pediatrics. In “Medicaid Managed Care Structures and Care Coordination: A National Cross-Sectional Analysis,” Gilchrist-Scott and colleagues examine the degree to which state penetrance of Medicaid managed care structures (specifically, health maintenance organizations [HMOs] versus primary care case management [PCCM]) may incentivize care coordination. They find that states with lower HMO and higher PCCM penetrance exhibited greater care coordination on 2 parent-reported National Survey of Children’s Health (NSCH) metrics: access to care coordination and receipt of care coordination when needed. Given that NSCH data were cross-sectional and penetrance data were aggregated by state, no causal inferences can be made, but the findings are intriguing nonetheless. From low to high quintiles of HMO penetrance (and, conversely, from high to low quintiles of PCCM penetrance), access to care coordination fell roughly 5 percentage points, and receipt of care coordination when needed fell roughly 10 percentage points. This finding is not subtle and suggests that the choice of incentive structure may matter. Nor is this finding surprising, given the incentive structures themselves. Unlike PCCM, fully … Address correspondence to Paul J. Chung, MD, MS, Department of Pediatrics, University of California – Los Angeles, 10833 LeConte Ave, B2-433 MDCC, Los Angeles, CA 90095. E-mail: paulchung{at}mednet.ucla.edu