Available online 24 February 2023, 101451

Author links open overlay panel, , , AbstractBackground

The Extended Care Health Option (ECHO) Program is a TRICARE program aimed at reducing the disabling effects of chronic medical conditions for beneficiaries of the Department of Defense (DoD) healthcare program. However, little is known about military connected children enrolled in the program.

Objective

/Hypothesis: The aim of this study was to examine the demographic makeup of pediatric ECHO beneficiaries and their healthcare claims data. This is the first study to evaluate healthcare utilization of this subset of military dependents.

Methods

A cross-sectional study was performed evaluating ECHO enrolled pediatric beneficiaries and their health service utilization during 2017-2019. TRICARE claims and military treatment facility encounter data was utilized to evaluate health service utilization and identify the most frequently reported ICD-10-CM and CPT codes associated with care for this population.

Results

Of the 2,001,619 dependents age 0-26 years who received medical care in the Military Health System (MHS) during 2017-2019, 21,588 individuals (1.1%) were enrolled in ECHO. Majority of encounters (65.4%) were provided in the military treatment facilities (MTFs). Inpatient visits, therapeutic services, and in-home nursing care were the top utilized private sector care services. Outpatient visits encompassed 94.8% of health care encounters, and neurodevelopmental disorders were the top principal diagnoses among ECHO beneficiaries.

Conclusions

With the increasing prevalence of children with medical complexity and developmental delay, the pediatric TRICARE beneficiaries eligible for ECHO will likely continue to rise. Improving services and supports for military children with special health care needs is needed to maximize their developmental trajectory.

Section snippetsIntroduction:

TRICARE is the worldwide Department of Defense (DoD) healthcare program that provides health benefits and healthcare support to 9.6 million Uniformed Services members, retirees, and their families.1 There are a variety of coverage plans, programs, and services aimed at providing comprehensive, low-cost, long-term healthcare for service members and their dependent family members. Extended Care Health Option (ECHO) is one such TRICARE supplemental service that provides eligible beneficiaries

Study Design and Study Population:

We conducted a cross-sectional analysis of the Military Health System Data Repository (MDR) claims database for Fiscal Years (FY) 2017-2019. The MDR captures encounter and claims data of care delivered at Military Treatment Facilities (MTFs/direct care) and at civilian fee-for-service facilities (private sector care) covered by TRICARE. TRICARE is the worldwide Department of Defense (DoD) healthcare program which provides universal coverage to approximately 9.6 million beneficiaries, which

Population Demographics

We identified a total of 2,001,619 dependents ages 0-26 years who received medical care in the MHS during FY 2017-2019 (Table 1). Of these, 21,588 individuals (1.1%) were enrolled in ECHO.

The greatest number of children enrolled in ECHO were of White race (67.6%), male (74.3%), and age 5-9 (36.9%). Pediatric beneficiaries enrolled in ECHO were older and a higher percentage were male when compared to their non-ECHO enrolled counterparts. The majority of ECHO enrolled children were dependents of

Discussion

We identified that 1.1% (21,588) of military dependent children were enrolled in ECHO during FY 2017-2019. Within the CSHCN population, there is a small subset of children with medical complexity (CMC) who are medically fragile and require intensive health care needs. CMCs “represent <1% of U.S. children yet account for more than one-third of total pediatric health care costs.”8 Pediatric ECHO beneficiaries encompass the population of military CMCs. In this study, children enrolled in ECHO had

Conclusions

Of the 2,001,619 dependents age 0-26 year old who received medical care in the MHS during FY 2017-2019, only 21,588 individuals (1.1%) were enrolled in ECHO. Pediatric ECHO beneficiaries were older (age 5-14) and there was a higher percentage of males when compared to non-ECHO enrolled counterparts. On average, children enrolled in ECHO had an annual mean of 16 outpatient visits and one hospitalization per year, and utilized a substantial amount of therapeutic, home care, and care coordination

Funding:

This study was funded through the Comparative Effectiveness and Provider-Induced Demand Collaboration (EPIC)/Low-Value Care in the National Capital Region Project, by the United States Defense Health Agency, Grant # HU0001-11-1-0023.

Disclosures and Conflicts of Interest:

The authors have no financial relationships or conflicts of interest relevant to this article to disclose. Accepted for poster presentation at the 2023 AMSUS Annual Meeting in February, 2023, at National Harbor, MD.

Disclaimer:

The views expressed are those of the author and do not necessarily reflect the official views of the Uniformed Services University of the Health Sciences (USUHS), Walter Reed National Military Medical Center, The Henry M. Jackson Foundation (HJF), the Department of Defense, U.S. Army, Navy, or Air Force. This study was exempted by the USUHS Institutional Review Board.

Acknowledgements:

We acknowledge the Clearinghouse for Military Family Readiness at The Pennsylvania State University for assistance with the preliminary literature search for this study.

REFERENCES (22)K.R. Aronson et al.Understanding military families who have dependents with special health care and/or educational needs

Disability and Health Journal

(2016)

M.E. Warfield et al.Health care utilization among children with chronic conditions in military families

Disability and Health Journal

(2018)

Evaluation of the TRICARE Program Fiscal Year 2017 Report to Congress. (2017). Defense Health Agency....Department of Defense Guide for Adults with Special Needs. (2015, May). Military OneSource. Retrieved on Feb 17, 2022,...National Survey of Children’s Health (NSCH) | MCHB. (2021, December). Retrieved on Feb 17, 2022, from...National Survey of Children’s Health Interactive Data Query. (n.d.). Data Resource Center for Child and Adolescent...C.R. Huebner et al.Health and Mental Health Needs of Children in US Military Families

Pediatrics

(2019)

P.W. Newacheck et al.A National Profile of Health Care Utilization and Expenditures for Children With Special Health Care Needs

Archives of Pediatrics & Adolescent Medicine

(2005)

N.A. Murphy et al.Children With Medical Complexity: The 10-Year Experience of a Single Center

Hospital Pediatrics

(2020)

N.A. Murphy et al.Children with Complex Medical Conditions: an Under-Recognized Driver of the Pediatric Cost Crisis

Current Treatment Options in Pediatrics

(2016)

E. Cohen et al.Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

Pediatrics

(2011)

View full text

© 2023 Elsevier Inc. All rights reserved.