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Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies

  • Tumaini R. Coker
    Correspondence
    Address correspondence to Tumaini R. Coker, MD, MBA, David Geffen School of Medicine at UCLA, UCLA/RAND Center for Adolescent Health Promotion, 10960 Wilshire Blvd, Suite 1550, Los Angeles, California 90024.
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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  • Helen M. DuPlessis
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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  • Ramona Davoudpour
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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  • Candice Moreno
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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  • Michael A. Rodriguez
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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  • Paul J. Chung
    Affiliations
    Department of Pediatrics, Mattel Children’s Hospital, David Geffen School of Medicine at University of California, Los Angeles, Calif. (Dr Coker, Dr DuPlessis, Dr Davoudpour, Dr Chung); RAND, Santa Monica, Calif. (Dr Coker and Dr Chung); Department of Community Health Sciences (Dr DuPlessis), Department of Epidemiology (Ms Moreno), and Department of Health Services (Dr Chung), UCLA School of Public Health, Los Angeles, Calif. and Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif. (Dr Rodriguez)
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Published:November 11, 2011DOI:https://doi.org/10.1016/j.acap.2011.08.003

      Abstract

      Objective

      The aim of this study was to examine the views of key stakeholders in health care payer organizations on the use of practice redesign strategies to improve the delivery of well-child care (WCC) to low-income children aged 0 to 3 years.

      Methods

      We conducted semistructured interviews with 18 key stakeholders (eg, chief medical officers, medical directors) in 11 California health plans and 2 medical group organizations serving low-income children, as well as the 2 state agencies that administer the 2 largest low-income insurance programs for California children. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis.

      Results

      Participants reported that nonphysicians were underutilized as WCC providers, and group visits and Internet services were likely a more effective way to provide anticipatory guidance and behavioral/developmental services. Participants described barriers to redesign, including the start-up costs required to implement redesign as well as a lack of financial incentives to support innovation in WCC delivery. Participants suggested solutions to these barriers, including using pay-for-performance programs to reward practices that expanded WCC services, and providing practices with start-up grants to implement pilot redesign projects that would eventually become self-sustaining. State-level barriers included poor Medicaid reimbursement rates and disincentives to innovation created by current Healthcare Effectiveness Data and Information Set measures.

      Conclusions

      All stakeholders will ultimately be needed to support WCC redesign; however, California payers may need to provide logistic, design, and financial support to practices, whereas state agencies may need to reshape the incentives to reward innovation around child preventive health and developmental services.

      Keywords

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