Understanding Early Intervention Value: Investigating the Effect of a Statewide Care Coordination Model on EI Resource Use and Outcomes

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Abstract Infants and toddlers with functional limitations are an important population because they represent a prevalent (i.e. 17% of children) and costly group that warrants greater attention on value-based delivery of developmental and therapeutic (i.e., physical therapy) services. The most common therapy service delivery system for this population is Part C Early Intervention (EI), which cost the federal government $460 Million in 2017. Family-centered care coordination (FC-CC) is a federal EI mandate and the “lynchpin” of value- based pediatric service delivery. Yet, little is known about how states comply with their FC-CC mandate or how FC-CC influences EI child and family outcomes. We propose to fill the knowledge gaps surrounding the provision and implementation of FC-CC using a mixed methods approach. First, we seek to understand the effect of a statewide EI FC-CC model called Global Outcomes for Infants and Toddlers (GO4IT). GO4IT integrates family assessment, care planning processes, outcomes measurement with the goal of identifying salient family needs, individualizing service type and intensity, and improving global measures of child function. Our quantitative analysis will use state EI administrative databases for Colorado (n≈ 75,600) and Massachusetts (n≈ 78,500) and is in the context of state-wide implementation of GO4IT, which provide an “exogenous shock” to value-based EI service delivery that allows us to examine changes in EI service use and outcomes before and after GO4IT. The implementation of GO4IT is analogous to a “natural experiment” with a treatment state, Colorado, which implemented GO4IT during the sample period, and a comparison state which did not (Massachusetts). We hypothesize that GO4IT will result faster time to treatment success (Aim 1), better outcomes and less spending (Aim 2) compared to EI service delivery in MA. Yet, testing this hypothesis requires an examination of more than utilization, cost, and outcomes. Thus, our qualitative study (Aim 3) will provide a more nuanced picture of specific FC-CC activities in which EI programs are engaged and allow us to define and assess specific approaches. In doing so we seek to provide evidenced-based recommendations as a guide for EI programs who strive to improve the value of their programs. In Aim 3, we will conduct about 30 interviews with EI stakeholders (state EI coordinator and data manager, EI providers, and parents in CO and MA [representing 5-6 influential EI program catchment areas per state] to determine FC-CC mechanisms, successes, and best practices. GO4IT is one example of a service delivery package designed to best meet the needs of families while also providing information for families and EI providers to promote family engagement in care planning and optimal outcomes. Given the dearth of evidence we hope our study provides evidence that is used to inform future efforts to implement family- centered care coordination programs. The proposal aligns with AHRQs funding priorities of value-based care, includes the priority population of children with special health care needs, and aligns with the Health Services Research Priorities for Achieving a High Value Healthcare System (NOT-HS-19-011) with a focus on children ages 0-3.