|
Executive Summary
The Children's Health Insurance Program (CHIP) of Texas began
providing coverage in May 2000. This report, completed by ICHP, was
designed to evaluate the quality of care provided in CHIP, including an
assessment of 13 major aspects of care. The overall results of the
report are positive and highlight that:
- 98 percent of families find the CHIP application process easy.
- 97 percent of children are healthy.
- After obtaining CHIP coverage, 92 percent of children have a usual
place to go for health care.
- Most families are "usually' to "always" satisfied
with services provided.
- Opportunities exist for improvement in some areas, notably asthma
treatment, completion of immunizations, and aftercare services for
children discharged from behavioral health hospitalizations.
The data sources for the evaluation included CHIP enrollment, claims,
and encounter data, as well as the results of several structured surveys
that were administered by telephone. Telephone interviews were completed
with a total of 6,517 families. Sampling for the interviews was designed
to ensure that important feedback could be obtained from families newly
enrolled in the program, families enrolled for a period of time in the
program, and also from families that had left or disenrolled from the
program before the end of 12 months of continuous eligibility. The study
was also designed so as to provide quality results for 13 health care
plans and for 18 geographic regions.
Detailed major positive findings are as follows:
- Families were interviewed to determine how they learned about
CHIP. Although there were some differences in responses according to
race and ethnicity, it was important to learn that respondents
identified all the methods that have been employed to spread the
word about this program. This finding underscores the success of
strategies used thus far, the importance of continuing to use a
variety of strategies to advertise the program, and gives useful
information for designing successful outreach strategies for certain
groups.
- Telephone surveys revealed that an overwhelming 98 percent of
families found the application process to be easy to understand and
convenient and the majority of children began receiving coverage
within 1-2 months of submitting applications.
- Family responses to specific telephone interview questions
revealed that 97 percent of children in the sample are healthy. Only
3 percent of children were determined to have special health care
needs, based on self-assessment by the families.
- A goal of the program is to ensure that families have a designated
place where they can receive routine and preventive care because
this improves the chances of early detection of health care problems
and subsequent reduced cost of care. Also, it is a goal to redirect
non-emergent care away from emergency rooms, where alternatives are
available, because such care is expensive, does not promote
continuity of care or focus on preventive care, and may slow
services to those with actual emergencies. Telephone surveys
revealed that:
- Prior to CHIP enrollment, only 85 percent of families reported
they had a usual source of care, and 19 percent of those
families named the E.R. as their usual source of care.
- Within three months of enrollment in CHIP, 90 percent of
families reported they had a usual source of care and at 12
months post-enrollment in CHIP, 92 percent of families reported
they had a usual source of care.
- Most noteworthy, the location of the source of care shifted
dramatically post-enrollment. After one year in CHIP, only one
percent of families used the E.R. as their usual source of care,
compared to 19 percent pre-enrollment.
- Analysis of administrative data revealed that overall access to
care is excellent in CHIP, with 90 percent of children 1-to-2 years
of age, 82 percent of children 25 months-to-6 years of age, and 88
percent of children 7 through 11 years of age seeing their primary
care providers at least once in a 12-month period. Nationally, only
65 percent of uninsured children see a health care provider in 12
months.
Among the findings of the study that will be used to guide
improvements in CHIP are as follows:
- Family satisfaction with care was assessed by telephone survey
with families enrolled in the program for 12 months or more and
results, reported by health care plan and geographic sites, revealed
a range of findings. Overall, it was found that the majority of
families were "usually" or "always" satisfied
with care received in several critical areas: access to or getting
needed care, getting care quickly, communication with doctor,
interactions with office staff, and interactions with health plan
representatives. Although all of the plans generally performed well,
there were significant differences in performance between plans.
This information will be used by the health care plans and by HHSC
contract management to guide quality improvement activities.
- Immunizations were analyzed using encounter and claims data.
Results revealed that CHIP compliance on Diphtheria, Tetanus, and
Pertussis (DTP) and Polio vaccination regimens compares favorably
with 120 other health plans in the nation serving Medicaid
recipients. The CHIP Infuenzae rate was lower and the Hepatitis B
rate was significantly better than these 120 plans. These findings
will inform future immunization campaign design as well as be used
for contract compliance.
- One of the primary strategies in preventing behavioral health
inpatient re-admission is for patients to be seen for follow-up
after discharge from inpatient care. An analysis of encounter and
claims data revealed that slightly more than half of persons served
in 2,713 behavioral health inpatient stays had follow-up with either
a mental health or primary care outpatient care provider within 30
days of discharge. There was also variability according to plan.
Nationally, commercial plans report that 71 percent of enrollees
receive an outpatient visit within 30 days of discharge from
behavioral health inpatient stays. This finding will be used to
examine the adequacy of provider networks as well as the community
characteristics in which some of the poorest performing plans are
operating.
- A group of 830 children with asthma was studied. It was
determined, through claims analysis, that only 43 percent had a
prescription filled for any of the recommended asthma drugs. This
compares to 36 percent in a similar program in Florida. Telephone
surveys revealed that one-third of the families did not understand
what their children's doctors were telling them about asthma; and
one-quarter of the families indicated their children were not taking
their asthma medications properly. These results are consistent with
concerns already documented and will be used for a variety of
purposes including to help shape the asthma pilots currently
underway, to target strategies for the health care plans to train
providers both on methods of treatment and ways to successfully
educate families, as well as for contract monitoring.
- Children's health care status was measured through telephone
interviews. It was determined that overall, CHIP participants are
very healthy. Telephone interviews revealed that a total of three
percent of children were rated by parents or caretakers as having
special health needs. A review of claims data for this same group
revealed these children had about eight times the health care
expenditures per month compared to children who did not have any
special health care needs, based on the interview instrument. These
families were generally less satisfied than other families
concerning getting needed care and with physician communication but
were more satisfied about the timeliness of care given. Although it
is excellent news that so many children in CHIP are healthy,
findings from the study underscore the complexities involved in
serving children with special health care needs. Opportunities for
improvement in this area will be addressed through program
development, member and provider education, as well as contract
management.
HHSC currently has several initiatives underway to promote outreach
efforts for CHIP and Medicaid. Additionally, a quality project is
underway to foster improved asthma treatment and education for children
and families. The findings of this report will be used to inform and
guide the activities of these projects and other quality strategies
designed to promote continuous quality improvement (CQI) in services and
care. Additionally, HHSC has initiated a formal CQI response process for
all external quality review reports. This process will guide systematic
improvements in a prioritized manner. Some of the priorities for this
report will include further analysis, if indicated, and actions to
address: use of urgent care centers by families as a usual source of
care; immunization rates, services to children with asthma; services to
African-American and Hispanic families; outpatient follow-up after
behavioral health inpatient stays; renewal strategies; and variations in
costs and levels of satisfaction between health plans.
Report: Quality
of Care in the Children's Health Insurance Program in Texas
(pdf document - 1,301kb - download
free Acrobat Viewer here)
Back to Chip Home | Top
of Page |
