Disclaimer: Moving Health Care Upstream is a collaborative effort co-led by Nemours Children’s Health System (Nemours) and the Center for Healthier Children, Families & Communities at the University of California- Los Angeles (UCLA). The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of Nemours, UCLA or the Moving Health Care Upstream initiative.
Nemours is excited to release a new toolkit titled “Medicaid Prevention Pathways”—developed with funding from the Robert Wood Johnson Foundation—for state Medicaid officials and managed care organizations (MCOs) with Medicaid and Children’s Health Insurance Program (CHIP) enrollees. One of the key tools is a Roadmap that illustrates the range of Medicaid and CHIP options that states can use to sustain approaches that link traditional clinical preventive care with community-based initiatives (“clinic to community”) to address chronic disease, and how best to successfully put these strategies in place on the ground. The Roadmap demonstrates through examples how states have extensive flexibility under current law to finance these strategies through Medicaid and CHIP for preventing chronic disease, including childhood obesity, at both the individual and population levels.
This toolkit, including the Roadmap, emerged through Nemours’ recognition that the most effective strategies for addressing disease prevention, including childhood obesity, target people in multiple places where they spend their time – the home, school, community, and health care settings. Additionally, we believe that these clinic to community preventive initiatives – especially those that focus on upstream social, environmental, and economic services – have the greatest potential to impact health outcomes.
The Roadmap highlights the tremendous amount of flexibility that exists under the current Medicaid program for states to implement prevention strategies. It provides 40 examples of state prevention activities across 23 states in fee-for-service and managed care environments, for childhood obesity and other conditions. It categorizes states’ prevention activities along a continuum of five main categories (shown below) from individual level (IL) engagement, with services targeting individual Medicaid enrollees, to population level (PL) engagement, with services and strategies targeting an entire geographic area including non-Medicaid enrollees. One IL example is Nationwide’s accountable care organization (ACO) in Ohio that deploys mobile care centers to serve Medicaid-eligible children in schools and communities. Oregon is a PL example as it provides flexible coverage for upstream services addressing wellness, mental health and housing support.
Understanding that states like to learn from one another, we provide high-level descriptions of what these 23 states are doing, while also linking to the source documents for those interested in more detail. We also recognized the need to do a deeper dive beyond just what is being funded, but how those decisions are being made and implemented. We selected two states (Washington and Oregon) and an ACO (Nationwide Children’s Hospital) that are currently involved in innovative upstream and population health activities and profiled how those states/ACO have been so successful in a set of case studies.
Finally, our toolkit also includes a White Paper that discusses accelerators, barriers and conditions of success for other states interesting in adopting these strategies. To learn more about, or to access, our Medicaid Prevention Pathways toolkit, please see: Pathways through Medicaid to Prevention: Realizing the Promise of Population Health.
