After months of research with local stakeholders, L.A. Care Health Plan and Children’s Hospital Los Angeles (CHLA) have unveiled their inaugural LA County State of Children’s Health report.
The report is made up of four policy briefs on the top issues affecting kids in the area, including resiliency, vaccinations, the child welfare system and the transition to adulthood. The hospital and publicly operated health plan established workgroups on each topic, then met in a roundtable in November 2023. The experts weighing in included school, public safety, public health and child welfare officials. A consistent theme was the need to engage trusted community partners who can promote engagement in care.
An independent national research firm, Health Management Associates, also provided subject-matter expertise and prepared the policy briefs. Special focus was paid to historically disadvantaged populations. The workgroups will continue working through at least 2026.
“Post-pandemic, a lot of the issues were quite magnified in child health,” Mona Patel, M.D., chief integrated delivery systems officer at CHLA, told Fierce Healthcare. “If we can get groups together to focus over the next couple of years and inform policy, that would be an extraordinary thing, if we can impact health outcomes for the next generation.”
Recommendation highlights include establishing new school-based programs to improve mental healthcare, launching an effort to dispel vaccine myths and addressing resource challenges that kids experience in the county.
“Children are our future, so if we can’t take good care of them and get them to a good foundation of health and wellness, then it really messes them up for the rest of their lives and possibly our future as a nation,” Alex Li, M.D., chief health equity officer at L.A. Care, told Fierce Healthcare.
The four policy briefs in the report follow:
Children and families’ resiliency
Kids’ mental health has been exacerbated by COVID-19, mass shootings, climate change and other major crises, the report said. These issues underscore a need to shift from a predominantly medical model, which includes screening, evaluation and diagnosis, toward an upstream model of support that includes crisis prevention and building resilience to reduce the need for treatment.
“This was a very challenging group because resilience is a hard, kind of tiered question, something that is challenging to define,” Patel acknowledged. Who is responsible for mental health—families, schools, doctors? Ultimately, Patel said, the group decided it is a shared responsibility. The next phase is figuring out where funding for support will come from, she added.
The report highlighted several financial opportunities, including the Student Behavioral Health Incentive Program. The outcomes of the program, intended to promote engagement between managed care organizations and local educational agencies, were previously reported on by Fierce Healthcare.
The brief recommended establishing a school-based working group and specialized county-focused department to enhance mental healthcare in a school setting and increase cross-sector collaboration to better triage behavioral health needs.
Vaccine catch-up and misinformation
Routine childhood vaccination rates dropped significantly during COVID, particularly among kids enrolled in Medicaid. Vaccination disparities were also more prevalent among Black and Latino kids compared to white and Asian kids.
In general, the vaccine distribution system is disparate and complex. During COVID, there were temporary improvements to this system, but many policy changes that supported this have since been rolled back, per the report.
L.A. Care is trying to work with the Los Angeles Unified School District to set up schools as vaccine sites, but that is not a typical approach in the U.S., Li noted. “We tend to say that’s a healthcare issue, go to your doctor,” he said.
Mistrust in vaccines, proliferated by misinformation online, demands better translation of science through channels that communities trust. The brief suggested leaning on community-based organizations, and that data sharing is crucial to inventory management and epidemiologic analyses of populations when it comes to vaccine coverage.
Other recommendations included creating a resource repository with digestible and up-to-date information on vaccine safety, as well as investing in data system improvements to collect more data on race and ethnicity.
Supporting kids involved in the child welfare system
The LA County Department of Children and Family Services is the largest child welfare system in the country and faces many challenges like coordinating care across many systems. The brief identified several system changes affecting kids in the welfare system, including expanded benefits under CalAIM.
Recommendations called for additional analyses to determine differences in outcomes between kids in managed care versus fee-for-service Medi-Cal. The brief also called for developing collaboratives and pilots to facilitate the successful implementation of new Medi-Cal benefits. And it recommended engaging partners in long-term planning for the next wave of proposed policy changes.
Kids with complex medical needs transition to adulthood
Youth with complex conditions face greater challenges when transitioning from pediatric to adult health systems, per the report. Less than a fifth of teens with special healthcare needs receive adequate transition support in California. These youth may get healthcare through a variety of insurance paths until they face changes starting at ages 18 through 21 and extending until 26. Given the lack of standardized transition processes, this can be a highly disruptive transition.
The brief recommended increasing access to an appropriate care network, like through the expansion of existing Medi-Cal Centers of Excellence. As one example, L.A. Care has partnered with the University of California, Los Angeles (UCLA) to refer complex patients to their sites of care. UCLA has wraparound services and specialists who have more time to spend with patients, Li explained. And in turn, he added, UCLA has expressed gratitude for being able to serve such an interesting population.
Primary care staff at federally qualified health centers should be trained in care coordination and case management of complex diseases and facilitate referrals to subspecialists. The brief also advocated for improving payment models for this population, like continuous Medi-Cal coverage and expansion of eligibility criteria for specific programs within Medi-Cal. “Reimbursement is a big deal. Reimbursement’s always going to be a big deal,” Patel said.
Finally, the report recommended investing in case management infrastructure and improving data exchange across systems, particularly between managed care, providers and non-medical stakeholders.