Electronic Information Exchange for Children in Foster Care

1. May 17, 2012 Electronic Information Exchangefor Children in Foster Care Beth Morrow Director, Health IT Initiatives The Children’s Partnership Congressional Briefing -- Improving Medicaid Mental Health Services for Children

2. Children in foster care rely on Medicaid for their health care www.childrenspartnership.org 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.

3. Mental health issues are pervasive and expensive in this population www.childrenspartnership.org 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%)

4. Coordinating care for this population is a challenge www.childrenspartnership.org • Children in foster care need a cross-system approach to care, to ensure coordinated behavioral and medical care. • 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.

5. Building an electronic health record for children in foster care: Examples www.childrenspartnership.org Wraparound Milwaukee Operating since 1999. Serving about 1,000 children annually. Uses an internet-based electronic record system to track, manage, and coordinate care for children at risk of institutional placement (foster care and juvenile justice). 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.

6. Wraparound Milwaukee -- Better Outcomes at Lower Cost www.childrenspartnership.org 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 norm. 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%.

7. Other Examples: www.childrenspartnership.org 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.

8. Other Examples: www.childrenspartnership.org Texas – Health Passport (since 2008) Reported results: • Reduction in the duplication of services. • Improved care coordination and data sharing among a child’shealth care providers. • Improved monitoring of compliance with prescription regimens. • Enhanced preventive care through improved documentation ofTexas 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.

9. Other HIT tools can help improve Medicaid mental health care, as well: www.childrenspartnership.org • 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 locally.

10. What we’re working on and why: www.childrenspartnership.org 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.

11. Conclusion: www.childrenspartnership.org 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.

12. Contact Beth Morrow (718) 832-6061 bmorrow@childrenspartnership.org www.childrenspartnership.org/electronicinfoexchange