Value-Based Payment to Support Health Care Transition for Young Adults with Intellectual and Developmental Disabilities: A Feasibility Study

• Published in: Maternal and child health journal Vol. 28; no. 5; pp. 789 - 797
• Main Authors: McManus, Margaret, White, Patience, Beers, Nathaniel, Levey, Eric, Coy, Nadine, Caulker, Jalima, Gaither, Takisha, Schmidt, Annie, Ilango, Samhita
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2024; Springer; Springer Nature B.V
• Subjects: Care and treatment; Child development deviations; Collaboration; Continuity of care; Demographic aspects; Developmental disabilities; Economic aspects; Feasibility studies; From the Field; Government programs; Gynecology; Health aspects; Health care; Maternal and Child Health; Medicaid; Medicine; Medicine & Public Health; Payments; Pediatrics; Population Economics; Psychological aspects; Public Health; Relative value scale payment systems (Medical care); Sociology; Transitional care; Young adults; United States; Young adults; Feasibility study; Health care transition; YSHCN; Value-based payment; Intellectual and developmental disability
• ISSN: 1092-7875; 1573-6628; 1573-6628
• DOI: 10.1007/s10995-023-03835-w

Introduction Only 20% of youth with intellectual and developmental disability (ID/DD) receive health care transition (HCT) preparation from their health care providers (HCPs). To address HCT system gaps, the first-of-its-kind HCT value-based payment (VBP) pilot was conducted for young adults (YA) with ID/DD. Methods This feasibility study examined the acceptability, implementation, and potential for expansion of the pilot, which was conducted within a specialty Medicaid managed care organization (HSCSN) in Washington, DC. With local pediatric and adult HCPs, the HCT intervention included a final pediatric visit, medical summary, joint HCT visit, and initial adult visit. The VBP was a mix of fee-for-service and pay-for-performance incentives. Feasibility was assessed via YA feedback surveys and interviews with HSCSN, participating HCPs, and selected state Medicaid officials. Results Regarding acceptability, HSCSN and HCPs found the HCT intervention represented a more organized approach and addressed an unmet need. YA with ID/DD and caregivers reported high satisfaction. Regarding implementation, nine YA with ID/DD participated. Benefits were reported in patient engagement, exchange of health information, and care management and financial support. Challenges included care management support needs, previous patient gaps in care, and scheduling difficulties. Regarding expansion, HSCSN and HCPs agreed that having streamlined care management support, medical summary preparation, and payment for HCT services are critical. Discussion This study examined the benefits and challenges of a HCT VBP approach and considerations for future expansion, including payer/HCP collaboration, HCT care management support, and updated system technology and interoperability. Significance What is already known on this subject? Little is known about the design and implementation regarding the use of VBP methods for HCT. Research shows that having a structured HCT process improves outcomes for YSHCN, including those with ID/DD. What does this study add? This study represents a unique collaboration between a Medicaid payer and pediatric and adult HCPs to pilot a recommended HCT intervention with a VBP structure to address the HCT system gap for YA with ID/DD. The study offers key considerations for future VBP efforts to improve the transition from pediatric to adult care for YA with ID/DD and other special health care needs.