School of Public Health

Washington Enhances Care Coordination

February 2017

Office of Healthy Communities | Healthy Starts & Transitions | Children with Special Health Care Needs Program

Washington State is taking a new approach to improve care coordination for children and youth with special health care needs (CYSHCN) who are largely under-identified in Medicaid's database.

The Predictive Risk Intelligence System (PRISM), managed by Medicaid and used by contracted managed care organizations (MCOs), identifies patients who could benefit from comprehensive services with care coordination. But due to certain design characteristics, CYSHCN are often overlooked.

In 2014, the Children with Special Health Care Needs (CSCHN) Program at the Department of Health proposed a data matching project that would specifically identify CYSHCN for enhanced care coordination services. The CSHCN Program team began with small sample data match to look for trends and then expanded the project to the entire PRISM database.

The team amended their existing data share agreement with Washington State Medicaid which allowed them access to the design of the PRISM database. They worked closely with the Health Care Authority (HCA) and the Research and Data Analysis (RDA) team from the Department of Social and Health Services and implement a flag in the database that appears on the records of any enrollee who receives CSHCN services.

The CSHCN Program team also partnered with HCA to develop quality improvement and assurance training and technical assistance for the CSHCN flag system. They held their first training for MCO staff at the end of 2016, it included a review of the data flow and background on the need for enhanced care coordination in the CYSHCN population.

The CSHCN Program continues to refine its approach and has plans to redesign the intake system that would improve data transfer to the Health Care Authority.

For more information about Washington's strategies to improve access to medical homes for children and youth with special healthcare needs please contact Maria Nardella at orĀ  Meredith Pyle at at the CSHCN Program.