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Kids Get Care ensures that children, regardless of health insurance status, receive early integrated preventive physical, developmental, mental health and oral health services through attachment to a health care home. This hand-out presents the program’s costs, benefits and potential to reduce health care costs.
PROGRAM COSTS and BENEFITS:
Start up costs: supported by U.S. Health Resources and Services Administration (HRSA) Community Access Program grant to design, develop, implement and evaluate program. $500,000 to $1 million per year over three years.
Short-term on-going costs: $38,400 to pay salary and benefits for one case manager at each site. Five to ten sites can share the services of one $48,000 per year community educator. Total annual case management and community education costs in 2002 at five sites were $240,000.
Table 1. Kids Get Care Costs and Activities, fiscal year 2002
|
Number of children
|
Costs per child per year
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Comparisons
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| Children screened by trained community staff |
17,286
|
$14
|
|
| Children with a medical home |
4,326
|
$55
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$418 for kids.health.2001 in Seattle and $268 for Healthy Spokane (Washington Health Foundation, Kids Campaign Report, 2002)
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| Children receiving case management services |
1,849
|
$130
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$300 to $500 per year are typical for case management interventions
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| Population of children at clinics |
11,164
|
$21
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Compare to $1.79 pmpm
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PROGRAM SAVINGS
Kids Get Care increases the delivery of comprehensive well child visits. Three clinics participating for two years increased their overall rate of two-year-olds up-to-date with well child visits by 41%, from 53% to 75%, representing 291 out of 379 young children. Research shows that Medicaid children who are up-to-date with well child checks have a 48% lower chance of having an avoidable hospitalization (Hakim, Pediatrics, 2001). A simulation of what would happen to the number of avoidable hospitalizations for children if Kids Get Care were in place throughout the state was run with statewide CHARS data, see below.
Table 2. Total costs of avoidable hospitalizations for two-year-olds in Washington State, 2002
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Total
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Private insurance
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Medicaid
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Other
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| Number of two-year-olds in WA |
78,369
|
48,891
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27,492
|
1,986
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| Costs of avoidable hospitalizations |
$4,984,591
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$1,503,062
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$3,120,671
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$360,858
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| Number of avoidable hospitalizations |
1081
|
499
|
539
|
43
|
| Number of admissions from the ER |
586
|
256
|
306
|
25
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| Costs per avoidable hospitalization |
$4,613
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$3,015
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$5,790
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$8,392
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Table 2 shows that in 2002, Medicaid covered 35% of the two-year-olds in the state, yet it paid 63% of the total costs of avoidable hospitalizations for two-year-olds. Avoidable hospitalizations and their associated emergency room visits are amenable to reduction with appropriate primary care.
Table 3. Simulation of savings if Kids Get Care were availabe statewide, 2002
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Total
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Private insurance
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Medicaid
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Other
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| If Kids Get Care were statewide: |
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|
|
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| Number of avoidable hospitalizations |
|
|
442
|
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| Number of admissions from the ER |
|
|
251
|
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| Savings from hospitalizations |
|
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$561,605
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| Savings from avoided $550 ER visits |
|
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$30,288
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| Savings from one- and three-year-olds |
|
|
$1,183,785
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| Total hospital savings for zero to three-year-olds |
$1,775,678
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| Number of additional Kids Get Care sites at $40,000 per site |
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|
44
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Note: A technical appendix is available showing how the simulation numbers were calculated.
In addition to the medical savings identified above, a Washington Dental Service Foundation (WDSF) analysis shows potential savings of roughly $1.5 million statewide if fluoride varnishes were applied during well child visits for children ages zero to five instead of waiting to pay to fill the cavities that occur without this preventive treatment. WDSF, the University of Washington and Medical Assistance are promoting early fluoride varnishes and oral health care through the Access to Baby and Child Dentistry program. Kids Get Care refers young children to ABCD providers at two of its seven current sites in King County.
In summary, it would cost the same amount to continue to pay for avoidable hospitalizations and caries treatment as it would to implement a Kids Get Care site at 44 additional locations and pay for fluoride varnishes throughout the state. Re-engineering the delivery of children’s primary care services to provide greater support for preventive services can improve well child visits while reducing unnecessary hospitalizations and cavity treatment.
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