A new metric developed by the Oregon Health & Science University Oregon Pediatric Improvement Partnership, or OPIP, will measure and incentivize young children’s social-emotional health treatments from clinicians contracted with Coordinated Care Organizations. This effort aims to improve the health care system for patients from birth to 5 years old, for both immediate development benefits and long-term health outcomes.
Oregon’s Coordinated Care Organizations, or CCOs, provide community-based, integrated care for individuals covered under the Oregon Health Plan, serving roughly 93% of children enrolled in Medicaid across the state.
“What is measured is what is focused on and improved, so this is a critical step to ensure accountability within our health care system,” said Colleen Reuland, M.S., director of OPIP at OHSU and an instructor in pediatrics in the OHSU School of Medicine. “By moving from a system-level metric to a child-level metric, we will be able to track if children are receiving the services they need to be healthy and successful and incentivize the CCOs’ role in improvements.”
The novel metric will be implemented as part of the Oregon Health Authority’s CCO Incentive Metric program, beginning January 2025, and is a continuation of ongoing efforts by OPIP to improve how Oregon’s Medicaid system supports the social-emotional health of children.
Building a healthy foundation
Social-emotional health refers to the capacity of a young child, from birth to 5 years old, to form close and secure relationships with their primary caregivers, other adults and peers, as well as their ability to experience, manage and express a full range of emotions — all of which are key indicators of school readiness.
The first five years of a person’s life lay the foundation for long-term social, mental and physical outcomes, Reuland said. Research shows 80% of synaptic connections — the building blocks of healthy neurological development — are made by age 3, making early social-emotional health interventions for children critical for long-term health.
Without proper access to social-emotional services, including counseling and parenting support, children are at greater risk for delays and health impacts, such as heart or lung disease, during adulthood. Children from marginalized communities and those who have adverse childhood experiences are especially at risk.
OPIP leaders say access to services that support social and emotional health is more crucial now than ever before, particularly because early learning environments such as preschool and childcare have suffered during and following the COVID-19 pandemic.
“Pediatric providers are caring for a rising number of youths with anxiety and depression, substance use, suicidality and school absenteeism. It is imperative that we support children from a young age to prevent many of these challenges,” said Lydia Chiang, M.D., medical director of OPIP and clinical associate professor of pediatrics in the OHSU School of Medicine. “An incentive metric that pushes our health care system to focus on the healthy social-emotional development of young children and build up a behavioral health workforce to support their families will have enormous lifelong impact.”
From system-level to child-level
The current system-level, social-emotional health metric is based on CCOs attesting that they have completed a set of activities, including examination of their data and current network, engagement with community partners, and implementation of care action plans. Currently, CCOs meet the metric if they attest to these activities, without child-level improvements in services being required.
In 2025, this will change: The new child-level metric will be anchored to whether children receive services that are aligned with clinical recommendations and whether improvements in health have occurred.
Developed with input from more than 160 individuals, including parents of young children enrolled in CCOs and parent advocacy organizations, the child-level metric incentivizes CCOs to improve the breadth and depth of their services. It will specifically focus on children with social-emotional health issues. It is also designed to support billable community-based services, ensuring treatment can be provided across an array of health care environments, including behavioral health, primary care and community-based settings.
Amid Oregon’s growing pediatric behavioral health crisis, OPIP’s efforts are key to statewide health equity priorities, Reuland said, ensuring children are connected to high-quality, culturally and linguistically responsive behavioral health care, and allowing for improved monitoring and analysis of health inequities.
“What’s most important is that the populations most impacted have had a say in what is incentivized in the metric and how the metric was operationalized,” Reuland said. “We hope this change signals to community members that their children’s health and wellness is a top priority.”