Improving the quality and cost-effectiveness of publicly financed health care
Improving Coordination Between School-Based Health Centers and Medicaid Managed Care
For many residents of rural New Mexico, the local doctor's office can be many miles away. This was the case for 16-year-old Billy*, a participant in New Mexico's "Salud!" Medicaid managed care program who relied on his school-based health center (SBHC) for primary care services.
Billy went to school feeling tired and sick, and at his friends' insistence, stopped into the SBHC. By then, he was experiencing chest pain. The nurse practitioner was concerned and referred him to a local hospital, where Billy was rushed into open heart surgery after physicians discovered a large tumor in his chest.
"In this case, the sheer availability and accessibility of care saved [Billy's] life," stated Kari Nordby, director of New Mexico's Medicaid School Health Office. "Because of the rural area this student resides in, it is highly unlikely that he would have gone to a doctor's office that day." Billy's school-based health center was able to offer him extensive on-site and referral services because of New Mexico's efforts to integrate SBHCs into the state's "Salud!" Medicaid managed care program.
All students, regardless of their payer source, are eligible for SBHC services. While a few SBHCs existed around the state (and were popular among students in the schools they served), the centers were inadequately funded and had no standardized menu of services. Additionally, no established communications procedures existed between SBHCs and students' primary care physicians.
Through a four-year demonstration grant awarded by the Center for Health Care Strategies, officials of New Mexico's "Salud!" Medicaid Managed Care Program initiated "Salud! Comes to Your School," a project to link SBHCs with New Mexico's Medicaid managed care program. The Salud! project recognized SBHCs as providers and enabled SBHCs to increase, standardize, and bill Medicaid for health care services. Charting and billing protocols were also created, and communication links were established between SBHC practitioners, primary care physicians, and "Salud!" case managers. For services beyond the scope of SBHCs, referral practices were formalized.
"Salud! Comes to Your School" demonstrated significant success by:
- Increasing the number of "Salud!" recipients receiving regular EPSDT screenings in SBHCs by converting sports physicals to include all aspects of a wellness check;
- Establishing best practices for identifying and managing chronic diseases, such as depression, asthma, type II diabetes, and obesity;
- Developing infrastructure, communication, care coordination, and billing protocols;
- Increasing reliable funding through Medicaid managed care reimbursement and assuring SBHCs financial viability;
- and Enhancing care delivery and increasing services in SBHCs.
"Integrating school-based health centers into New Mexico's Medicaid managed care program allows us to provide accessible care to our school-age ‘Salud!' recipients," said Nordby. "We learned that many students accessing the centers often don't visit their primary care physicians and wouldn't have sought or received care elsewhere. In order to ensure the availability of care for this population, the survival and quality of these centers is imperative."
Based in large part on the success of "Salud! Comes to Your School," New Mexico Governor Bill Richardson introduced legislation to double the number of school-based health centers from 38 to 64, making at least one available in every county in the state. The legislation was passed in March 2005 and plans are underway to build more SBHCs to help kids like Billy get the health care they need.
*Name has been changed to protect privacy.