Outcomes

Disclosure

• Authors have no relevant financial relationships to disclose or COIs to resolve
• This presentation will not involve discussion of unapproved or off-label, experimental, or investigational use of any products, drugs, or devices

Background

• 8 million US children (6%) uninsured
• 62-72% of uninsured US children (up to 3.5 million) eligible for but not enrolled in Medicaid/CHIP
• Major racial/ethnic disparities exist
  • Only 5% of white children uninsured, vs. 8% of African-American and 12% of Latino children
• But not enough known about most effective ways to insure uninsured children
• No study has examined effectiveness of Parent Mentors (PMs)

Study Aim

• To conduct randomized, controlled trial of effects of PMs on insuring uninsured minority children

• Design = randomized controlled trial
  • Called Kids’ HELP (Kids’ Health Insurance by Educating Lots of Parents)
• Uninsured, Medicaid/CHIP-eligible Latino and African-American children recruited at community sites and randomized to:
  • PMs
  • Control group
• Subjects in both groups contacted monthly by blinded research assistant to monitor outcomes for 1 year
  • Additional participants followed for up to 2 years after trial ceased
• Setting: 7 Dallas communities with highest proportion of uninsured and poor minority children
• Recruitment occurred at 97 community sites, including supermarkets, department stores, libraries, Goodwill stores, food banks, health fairs, churches, schools, and housing projects

Methods: Intervention

• PMs: minority parents in primary-care clinic who already had Medicaid/CHIP-covered children
• PMs underwent 2-day training session addressing types of insurance programs, application process, completing and submitting applications with parents, being family liaison/advocate with Medicaid/CHIP programs, renewing coverage, obtaining pediatric care, and helping families with food, clothing, and other social needs
• PMs met with families in their homes and at community sites and contacted them regularly via phone, e-mails, and texting
• Controls received Texas’s traditional Medicaid/CHIP outreach and enrollment

• Outcomes assessed monthly:
  • Proportion of children obtaining health insurance
  • Time interval to obtain insurance
  • Coverage renewal
  • Access to medical and dental care
  • Out-of-pocket costs of care and family financial burden
  • Parental satisfaction
  • Quality of care
• We used 82-item baseline and 67-item 12-month and long-term questionnaires (derived from national surveys and published studies)
• Cost-effectiveness analysis performed

Obtaining Health Insurance

• Significantly higher proportion of PM group obtained health insurance vs. control group, at 95% vs. 68% (P < .001)
• PM group had significantly higher adjusted relative risk (1.3; 95% CI, 1.2-1.3) and odds (2.9; 95% CI, 2.1-4.0) of insurance coverage
  • After adjustment for child’s age and gender, parental citizenship and employment, and family income

Adjusted Propensity Curve

Marked, sustained difference between groups in obtaining insurance emerged at 100 days

• PMs significantly more effective than traditional Medicaid/CHIP outreach and enrollment in
  • Insuring uninsured minority children
  • Obtaining insurance faster
  • Renewing coverage
  • Improving access to medical and dental care
  • Reducing unmet needs and out-of-pocket costs of care
  • Achieving parental satisfaction and quality of care
  • Teaching parents to maintain children’s coverage up to two years after intervention cessation
• PMs relatively inexpensive, at $53 per child per month, but highly cost-effective, saving $6,045 per child insured

• Given that 3.5 million US children uninsured and Medicaid/CHIP eligible, and 57% Latino or African-American, findings suggest implementing PMs nationally for minority children could save over $11.9 billion
• If PM intervention shown to be effective for all racial/ethnic groups, findings suggest implementing PMs nationally for all uninsured children could save $21.2 billion
• PMs and analogous peer mentors for adults could prove to be highly cost-effective interventions for eliminating disparities and insuring all Americans

• Flores G., Walker C., Lin H., Lee M., Fierro M., Henry M., Massey K., Portillo A. Design, methods, and baseline characteristics of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) trial: A randomized, controlled trial of the effectiveness of parent mentors in insuring uninsured minority children. Contemporary Clinical Trials 2015; 40:124-137. Article.
  
  
• Flores G., Walker C., Lin H., et al. A successful program for training Parent Mentors to provide assistance with obtaining health insurance for uninsured children. Academic Pediatrics 2015; 15:275-281. Article.
  
  
• Flores G., Lin H., Walker C., Lee M., Currie J., Allgeyer R., Fierro M., Henry M., Portillo A., Massey K. Parent mentors and insuring uninsured children: A randomized controlled trial. Pediatrics 2016; 137(4) e20153519. Article.
  
  
• Flores G., Lin H., Walker C., Lee M., Portillo A., Henry M., Fierro M., Massey K.  A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs. International Journal for Equity in Health 2016; published online before print. DOI 10.1186/s12939-016-0331-y. Article.