posted by Michael Rabkin, Passport
on November 21, 2016
It’s well documented that children in foster care are high utilizers of a variety of health-related services, and that foster care alumni have poorer long-term outcomes compared to their peers. In March 2015, Passport Health Plan – a provider-sponsored, nonprofit, community-based health plan that serves nearly 300,000 Medicaid beneficiaries in Kentucky – launched a pilot program to turn around negative outcomes for this population.
To get things started, Passport partnered with three state agencies – the Kentucky Department for Medicaid Services (DMS), the Department for Community Based Services (DCBS), and the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). Together we created a pilot program that would use the wraparound process (an intensive, individualized care management process for youths with serious or complex needs in which various individuals from various areas come together to help care for the youths) to provide intensive home- and community-based interventions to foster care children and their families. Children admitted to the program are at risk of being moved from their foster home due to behavioral health needs.
Passport entered into agreements with two providers, ResCare and Seven Counties Services (now Centerstone of Kentucky), to act as Intensive Care Management Organizations (ICMOs). The ICMO assigns each family an Intensive Care Coordinator, who facilitates the Child and Family Team and assists the team in developing and carrying out a coordinated care plan specific to the needs of the child and family. Each family also gets assigned an Intensive Home-Based Therapist. Therapy can be discontinued at any point after the initial assessment period.
Because providers are paid via a per-member-per-month (PMPM) rate, the program provides flexibility to meet the unique needs of each family, including allowing providers to implement services not included in the state Medicaid plan.
As of Nov. 10, 2016, 55 youth have participated in the program and there’s been statistically significant improvement in functioning during participation. Passport monitors for signs of stability post-discharge (such as reduced cost of behavioral health utilization, reduced number of foster home placements, etc.), but that data is not yet available.
The program has been quite successful for some families. For example, John (a beneficiary whose name has been changed to protect his privacy) was 9 years old when he was admitted to the program. John’s mother had been given multiple chances to complete her case plan and had not succeeded, so proceedings for termination of parental rights had begun. From the beginning, the Intensive Care Coordinator included John’s foster mother and his mother in the Child and Family Team, which set a goal to get John safely home with his mom. After much hard work, John was ultimately returned to his mother’s custody, while his foster mom remains a support to both of them.
The pilot has had broader impact as well. Its existence helped DBHDID move forward with bringing skills-based training, coaching, and other implementation support for the wraparound model to Kentucky. Lessons learned are shared with state partners to increase success of wraparound implementation, and data collected by Passport may influence policy decisions related to the state’s future payment model for wraparound as an intensive care coordination model.