An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort Study.

Abstract

Background: The California Advancing and Innovating Medi-Cal (CalAIM) initiative supports Enhanced Care Management (ECM) for high-need pediatric populations but published evidence of the impact of ECM in pediatric populations is lacking.

Objective: We evaluated a novel multidisciplinary care model (Pair Team) for delivering ECM services, focusing on implementation and early outcomes for children and adolescents enrolled in California's Medicaid program (Medi-Cal).

Methods: We conducted a retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents who enrolled in Pair Team's program between July 2022 and November 2024. Program engagement, health care engagement, and depressive symptoms were assessed using program data, electronic health records, and prescription data.

Results: The main cohort included 1294 enrollees with 12 months of follow-up data (mean age 8.9 years, 50.3% (651/1294) female, 81.8% (1058/1294) experiencing homelessness). Members averaged 2.8 interactions per month with care team members over the first 3 months and 57.1% (851/1491) were still enrolled at 12 months. In the year prior to enrollment compared to the year postenrollment, the prevalence of an asthma diagnosis increased from 7.8% to 10.0% (P=.005), outpatient visits increased 7% (rate ratio, RR=1.07, P<.001), emergency department visits decreased 9% (RR=0.91, P=.002), and antibiotic prescriptions increased 41% (RR=1.41, P=.001). For those with depressive symptoms at enrollment, mean PHQ-9 score decreased from 15.4 (SD 4.7) to 10.2 (SD 6.8) after 3 months (P<.001).

Conclusions: An innovative ECM program successfully engaged with and retained high-need pediatric Medicaid patients. Program members had higher engagement with other health care in the year following enrollment, and depressive symptoms improved. These results highlight the potential for this model to improve outcomes for the highest-need pediatric Medicaid patients.