– Tailored care and streamlining payment and insurance functions can help improve families’ experiences with special needs care for children with special needs, according to UnitedHealth Group’s report on its Special Needs Initiative.
“Despite the unique challenges these children and their families face, clinicians do not always have sufficient resources or training to care for them,” the report explained. “As a result, new partnerships between payers and providers are needed to implement programs that improve experiences and outcomes and lower the cost of care.”
In response to this challenge and need, UnitedHealth Group started its Special Needs Initiative. The program is based on UnitedHealth Group’s 11 health system partners.
In 2020, the Special Needs Initiative served more than 110,000 families in the US and the following year UnitedHealth Group expanded the program to serve adult populations. A child’s eligibility for the program is based on their age—under 18 years old—, one or more special health care need diagnoses, and a high needs score, which incorporates prior authorizations, out-of-pocket spending, inbound calls, and more.
Children in the program often have been diagnosed with conditions such as epilepsy, diabetes, autism, and other chronic conditions.
The program has five key components. It couples insurance and payment support with payer-provider partnerships and education opportunities. The program also supports families’ social determinants of health needs and prioritizes coordinating with healthcare organizations and experts to secure timely diagnostics for members.
By addressing these five areas, the UnitedHealth Group program saw improvements in both member experience and healthcare spending, based on data from 2017 to 2020.
The program resulted in a 76 point higher net promoter score. The net promoter score gauged the family experience for commercially-covered families with a child who has special needs on a spectrum from -100 points to 100 points.
UnitedHealth Group cited a few reasons for this improvement in member experience. Members and their families may have easier access to tests and treatments and greater flexibility in their provider options. When patient navigation of the healthcare system is more streamlined, they can spend their time and energy on what matters to them.
Overall costs dropped by $1,500 annually per participant. Out-of-pocket healthcare spending also decreased for some families. The report highlighted two families in particular that saw significant savings in the Special Needs Initiative. One family saved more than $3,000 because the program paired the family with a provider who properly coded the services.
The report added that a separate family saved more than $10,000 due to collaboration between the member’s pediatrician, physical therapist, and a medical equipment company on a wheelchair tailored to the member’s condition.
Savings and comprehensive insurance coverage are crucial for families who have children with special needs.
Nearly four out of ten families with children with special needs who were covered under commercial health insurance plans (38 percent) saw out-of-pocket healthcare costs of $1,000 or more and a quarter of commercially-insured families with children who require special needs care struggle to satisfy medical bill payments, the report said.
Payers have taken various approaches to supporting families of children with special needs. For example, Aetna established Here 4 U Sessions, peer support for women who have been experiencing pandemic-related stress including mothers of children with special needs.
A separate UnitedHealth Group initiative aimed to improve care for children with rare and complex diseases. The payer’s Family Engagement Center leverages a popular care management design, assigning a care coordinator to each member.
Despite commercial payers’ efforts, coverage for children with special needs can be a challenge to secure. Experts have suggested improving children’s health insurance coverage for children with disabilities by supplementing marketplace plans with Medicaid wraparound services.
#UHG #Initiative #Children #Special #Boosts #Net #Promoter #Score