P3.D062: HealthySteps in Arkansas: Building Sustainability and Statewide Access for Infants, Toddlers, and their Caregivers

Background: HealthySteps is an evidence-based, interdisciplinary pediatric primary care program that promotes nurturing parenting and healthy development for babies and toddlers. The model is designed to identify challenges for infants, toddlers, and their caregivers early to prevent problems from becoming worse (and more costly). With HealthySteps, doctors, nurses, front desk staff, and HealthySteps Specialists work together to support families to do their best for their youngest members, preparing them to reach their potential in school and life. The HealthySteps Specialist provides short-term behavior/development consultations, referrals, and intensive follow up care when needed, while supporting practice screening efforts. In Arkansas, a state that ranks at the bottom for most child well-being measures, HealthySteps is making population-level impact.

Project Description: In 2019, the Arkansas Chapter of the American Academy of Pediatrics (ARAAP) and Excel by 8 (E8 – a local organization focused on positive outcomes for young children and families) became interested in bringing HealthySteps to Arkansas. Simultaneously, Arkansas Children’s and clinics in their affiliated Arkansas Children’s Care Network (ACCN) also began conversations about a statewide implementation of HealthySteps. E8, ARAAP and ACCN coordinated efforts and applied for grant funding in 2021 to implement HealthySteps at 7 sites and establish sustainability for the model. Continued coordination between E8, ARAAP, ACCN, and the HealthySteps National Office has resulted in a statewide funding pathway through Medicaid, a comprehensive data system to capture outcomes and return on investment, and increasing demand for the program from pediatric sites across Arkansas.

Discussion: As sites onboard with HealthySteps, ACCN provides support to each location, ensuring that they have clarity in workflow, delineated staff responsibilities, and comprehensive data reporting ability. ARAAP successfully collaborated with Arkansas Medicaid and state legislators to pass and implement a supplemental Medicaid per-member, per-month payment for pediatric practice transformation models, including HealthySteps, through the state’s Patient-Centered Medical Home program. This generated increased interest in implementing HealthySteps in Arkansas, including academic and private-led sites in rural, suburban, and urban areas. Advocacy continues to encourage additional payers to support this model of care. Initial estimates of return on investment show a 218% return for every dollar invested in the program by Medicaid.

Conclusion: Today, these partners are leading a statewide rollout of a sustainable, team-based, evidence-based pediatric practice transformation model of care. ACCN plans to expand HealthySteps to nine additional sites in 2024. HealthySteps teams address family needs through direct services and closed loop referrals for issues including food insecurity, maternal depression, early intervention, and quality child care while also supporting physician perceptions of their own care. Leaning into each partner’s strength for advocacy, operations, and patient-centered care resulted in greater support for care teams, a centralized data system, and interest from public and private payers.