Progress Report: States’ Efforts on Integrated Care for Kids Model

March 7, 2022
New Jersey, North Carolina start enrolling children; Oregon pulls plug on project

Several of the seven states participating in the multi-year Integrated Care for Kids (InCK) alternative payment model are reporting making progress on pilot projects, although Oregon pulled the plug on its pilot, blaming onerous data collection requirements, according to a news report.

The InCK model is described as a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid through prevention, early identification, and treatment of behavioral and physical health needs. Almost $126 million in federal funding was awarded to seven states and lead organizations for a seven-year program. The participating states are Connecticut, Illinois, North Carolina, New Jersey, New York, Ohio and Oregon.

Some programs also include Children’s Health Insurance Program (CHIP) beneficiaries and pregnant woman over age 21 who are covered by Medicaid. The alternative payment model is designed to empower states and local providers to better address these needs, as well as the impact of opioid addiction through care integration across all types of healthcare providers.

Hackensack Meridian Health, in partnership with Visiting Nurse Association Health Group, and the New Jersey Health Care Quality Institute, has just begun seeing patients through the New Jersey InCK pilot, serving children who live in Monmouth and Ocean counties who are enrolled in FamilyCare (Medicaid).

NJ InCK will provide early assessment to identify children and adolescents who have significant health issues as indicated by their medical, behavioral, and social risks. This assessment — My HealthStory — is conducted via app or online and once it is complete, the family receives a verification email, which is then sent to their primary care provider. The children will be eligible to receive additional care coordination and case management services. These new services will be provided through Advanced Case Management Teams (ACMT) led by social workers, and including community health workers, child life specialists, and family support specialists.

Steven Kairys, M.D., professor of Pediatrics at Hackensack Meridian School of Medicine and the medical director of the New Jersey AAP Pediatric Council on Research and Education (PCORE), is the principal investigator of New Jersey Integrated Care for Kids (InCK).

“Despite longstanding efforts in New Jersey to coordinate care, there remain significant barriers that frustrate families and providers attempting to support children with complex needs,” said Kairys, in a statement. “The InCK model provides a federally authorized framework to break through the silos, reduce fragmentation, identify children in need, and facilitate care within the community. The model also puts the families at the hub of the service system.  This is an exciting opportunity to meaningfully improve the outcomes for children in Monmouth and Ocean counties.”

Breaking down siloes in North Carolina

In January 2022, North Carolina Integrated Care for Kids began enrolling children and youth from birth to age 21 who are insured by Medicaid or CHIP (NC Health Choice) and who live in five North Carolina counties: Alamance, Durham, Granville, Orange, and Vance.

A coalition of families and children in the NC InCK counties, Duke University, University of North Carolina at Chapel Hill (UNC), the state Department of Health and Human Services (NC DHHS), and community partners are leading the model work. While Duke, UNC and NC DHHS are the lead organizations, all children who are insured by Medicaid in these five counties will be included in the model, no matter where they receive care.

"The NC Integrated Care for Kids model is a tremendous opportunity for us to transform how we support the well-being of children and their families by breaking down siloes and working together across many systems, including health care, schools, child welfare, and early child care settings,” said Charlene Wong, M.D., NC InCK executive director, in a statement on the project’s web site.

One key strategy is better integrating data —bringing together information from multiple sources to give a complete picture of a child’s health, education, and social service needs alongside their caregiver needs. Another is identifying children and youth who could benefit from additional support — using the combined information to identify children who would likely benefit from additional support, and coordinate with families to support care across their service providers. 

In one example of an innovation, NC InCK created the Kindergarten Readiness Promotion Bundle to build upon healthcare providers’ existing efforts to provide direct services and to connect children to cross-sector programs and supports that will prepare children to thrive in kindergarten. 

During well visits from birth to age 6, providers will apply universal components to all children at specific ages and flexible need-based components for children with specific needs. The Kindergarten Readiness Promotion Bundle was developed through empirical evidence review, partner and advisory group input, and children’s health care provider feedback through interviews and focus groups. NC Medicaid created a new non-billable code to capture delivery of the Kindergarten Readiness Promotion Bundle in health care practices.   Through the NC InCK APM, practices can get credit for taking actions that support Kindergarten Readiness that are included in the Kindergarten Readiness Promotion Bundle. By linking these activities in the bundle with financial incentives for practices, NC InCK aims to connect more children to services that support their health and early learning.

Oregon drops out of program

Oregon chose to discontinue its InCK program, blaming onerous data collection requirements, according to a November 2021 article by Nick Budnick in the Lund Report, which focuses on healthcare policy issues in Oregon.

“After working for two years on the pre-implementation phase, state officials said they realized the federal government was not going to bend on certain standardized screening requirements intended for data collection and evaluation. The officials said the federal requirements stiffened after Oregon made its initial application,” the article noted.

“Over the summer and early fall, the Oregon team received clarifications from the federal funder regarding the Integrated Care for Kids (InCK) Model and their expectations,” said an email sent to OHA [Oregon Health Authority] staff by the InCK staff on Oct. 18. “A number of these clarifications require significant changes to the Oregon InCK Model and reporting requirements for 2022 that our collective teams feel are not viable to implement, as they would require us to divert our focus from the integration of services to data collection and data reporting.”

The article quotes state Health Policy & Analytics Division Director Jeremy Vandehey as saying that through the planning process the state has learned a lot around what data it has and doesn’t have, and how it could do this work differently going forward. “So while the grant is coming to an end … we think this has spurred some really great conversations and collaborative work on the ground that we hope will continue.”

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