Improving Health Outcomes for Children Through Adherence to Well-Child Visits

The Challenge: ​​

Children who experience significant adverse childhood experiences (ACEs) from infancy, such as a maternal depression, physical and emotional neglect, or unstable housing are likely to experience ramifications throughout their lives. It is more difficult to detect and address these needs among minority children and children living below the poverty line potentially in part because they are less likely to adhere to the recommended well-child schedule making it less likely to detect any challenges and needs for these families. Additionally, as many parents are on different insurance plans or uninsured, services are not available to them even though they will benefit the child throughout their lifetime.

Our Goal:

To improve screening and intervention rates for early child developmental and behavioral needs, maternal behavioral needs and family social determinant of health (“SDOH”) needs in the primary care pediatric setting among racial, ethnic and socioeconomic groups that tend to lag in these areas.

The Healthfirst Solution:

Healthfirst worked with NYC Health + Hospitals’ (“NYC H+H”) pediatric leaders to create a “Center of Excellence” model for Early Childhood Dyadic Care to support NYC H+H’s 3-2-1 IMPACT program. This program, partially funded by a Robin Hood Grant, provides early intervention services to support the health and well-being of young children and families. Following the New York State First 1,000 Days Advanced Pediatric Primary Care Model launched in 2017, Healthfirst worked with NYC H+H to outline the developmental, behavioral and SDOH supports children from infancy to age 4 and their families require, and then build a reimbursement model for both billable and non-billable services needed. Healthfirst and H+H shared data to understand both the costs and the outcomes of the model.

The model employs trained Healthy Steps workers who engage families during the visits to identify developmental issues, provide support and education. If higher-level needs are identified, more intensive services are available at the site in the form of parenting coaching or psychological counseling. Community health workers navigate families’ needs to ensure they get the services and engage in the care they need.

Population Health Improvements

We’ve seen promising baseline results after the first six months of the study.

• We found significant increases in any primary care (2.8 percentage points), well-child care (5.8 percentage points), and dental care (5.1 percentage points) utilization for IMPACT-enrolled members vs. controls.
• We also found an increase in early intervention services received by IMPACT group, but the increase did not reach statistical significance.
• Race stratification of results shows that Black, Hispanic and Asian and Pacific Islander groups that tend to lag on these visits and services had significant increases in these services comparable to other groups.

Takeaway:

Working directly with providers who are responsible for service provision, we are better able to create innovative programs and value-based payment models that are sustainable and achieve high-value outcomes for health equity.

The success of this program led to similar, separate programs with Healthfirst sponsor hospitals in Brooklyn and the Bronx.

Healthfirst also advocated for the adoption of continuous Medicaid coverage for children until they reach age 6 in New York State as a result of this program, which was adopted as part of the state budget in April 2024.