Parent mentors get uninsured kids insured

Compared with traditional Medicaid/Children’s Health Insurance Program (CHIP) outreach, the use of parent mentors (PMs) raises rates of insured minority children and improves healthcare access along with providing other benefits—including cost effectiveness—a new study shows.

Investigators conducted a yearlong trial in Dallas, Texas, communities with high proportions of low-income, minority families with uninsured children. The 237 parent participants, all of whom were Latino or African American, were assigned to either the group with which PMs engaged (via home visits and phone/e-mail/texts) or the control group. The PMs were parents with 1 or more children covered by Medicaid/CHIP who participated in 2-day training sessions that enabled them to assist families with insurance applications, retaining coverage, medical homes, and social needs. Those in the control group were given access to standard-of-care outreach/enrollment by Texas Medicaid/CHIP and were subject to a campaign to raise CHIP/Medicaid awareness that included bilingual advertisements, websites with application links and order forms, and daycare-center outreach.

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In the PM group, 95% of children obtained insurance compared with 68% of controls. The PM intervention also insured children more quickly and was more effective in renewing coverage. In addition, PMs were associated with improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after the intervention ended. Controls had higher total costs than the PM group for emergency department visits, hospitalizations, intensive care unit stays, and wage loss and other costs of caring for sick children. Investigators calculated that PMs, who received $53 per child per month and followed up to 10 families at a time, saved $6045 per year per child insured (Flores G, et al. Pediatrics. 2016;137[4]:e20153519).

Commentary: This is a great program! It provides a model for a cost-effective means of enrolling the 4 million insurance-eligible, uninsured children in the United States. Keep in mind that the parent mentors described here are not health professionals. They are essentially peers with just 2 days of training who step in to act like an experienced family member invested in getting children the healthcare they need. In the year of the study, these role models visited each of their assigned families a mean of almost 20 times and made more than 160 phone/text/email contacts. The results, including the cost savings, are impressive. —Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.