Child health problems that are caused or exacerbated by unhealthy behaviors remain a leading cause of medical spending for children. The authors examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year. Results show that enrolling more uninsured children in Medicaid and SCHIP could improve the chances that families receive advice about health behaviors and injury prevention.

Pay-for-performance (P4P) initiatives are being pursued by state Medicaid programs. In 2006, 28 states had adopted some type of initiative, half of which have been in existence for five years or more. However, policymakers have been given little information on the effectiveness of these initiatives in shifting physician practice. Program evaluations indicate that P4P, when combined with other quality initiatives, is associated with quality improvement; however, the role of P4P in contributing to those improvements often is unclear. This report, and the accompanying Policy Brief, reviews the available evidence on the issue and answers important questions.

As a mainstay of health coverage in the United States and one of the nation’s major health purchasers, Medicaid has an important role to play in moving health care quality efforts forward and improving quality for the populations it serves, especially children. This issue brief provides recommendations at the state and federal levels to improve quality in Medicaid.

Health information technology (HIT) is a key tool that both public and commercial insurers are employing to improve patient care and increase efficiency in the health care system. HIT can help measure quality, facilitate coordination of care, and help to bridge fragmented delivery systems and gaps in coverage. HIT can also help meet the needs of medically fragile populations, minimize unnecessary procedures, and reduce administrative costs. This issue brief highlights some ideas on ways in which states can use information technology to improve efficiency and quality of care in the Medicaid program.

The Commonwealth Fund 2006 Health Care Quality Survey found that when adults have health insurance coverage and a medical home, racial and ethnic disparities in access and quality are reduced or even eliminated. Replication of this model, particularly among safety net providers, could potentially improve the quality of care delivered to all patients while reducing disparities in care experienced by vulnerable populations.

The impact of individual behavior on the cost of health care is attracting a great deal of attention from policymakers, as a number of Medicaid programs are offering rewards for healthy behavior. States that provide incentives for behavior generally aim to either increase the number of beneficiaries who obtain regular health screenings or to decrease the incidence of smoking and obesity. This report comments that although these are valid goals for state Medicaid programs, there is little hard evidence that incentive programs will actually achieve these goals, particularly in terms of reducing smoking and obesity.

Providing better health care for children involves monitoring quality and making quality improvements, enrolling eligible children in Medicaid and SCHIP, and ensuring that health care systems are responsive to the unique health needs of kids. To discuss issues of quality and access, the Commonwealth Fund and the Alliance for Health Reform sponsored this briefing. A transcript of the briefing is provided, for additional resources, see the Alliance for Health Reform.

Over the past few years, pay-for-performance programs have emerged as a promising strategy to improve the quality and cost-effectiveness of care for Medicaid and SCHIP beneficiaries. In 2006, the Center for Health Care Strategies conducted a 50-state survey to identify innovative practices in the reimbursement of high-quality health care in the public sector. This guide offers lessons learned from Medicaid, Medicare, and commercial programs.

This chartbook summarizes current knowledge about health insurance coverage, the health needs of low-income children in the United States, and the roles that Medicaid and SCHIP play in improving children’s access to health care and their health status.

Conducted in the spring of 2006, this survey was designed to identify the ways in which state Medicaid and SCHIP programs are currently measuring the quality of care provided to children and families, including those with special needs. The results reveal that the majority of programs across the country are engaged in performance measurement and quality improvement activities of one kind or another, focusing heavily on pediatric preventive and primary care.

Having a usual source of care has been linked to many positive outcomes, such as increased use of preventive care, decreased use of emergency room care, and better continuity of care. This report synthesizes qualitative and quantitative evidence on the extent to which SCHIP enrollees report having a usual source of care.