Beyond Healthcare Utilization: A Whole-Child, Multi-Sector Approach to Pediatric Risk Stratification

Objectives: The North Carolina Integrated Care for Kids (NC InCK) pediatric demonstration model created a whole-child risk stratification approach to identify children for enhanced care management. Unlike traditional approaches that rely primarily on healthcare data, NC InCK integrates health, education, social, and juvenile justice data. We described the NC InCK risk stratification approach and compared its output to Medicaid managed care organization (MCO)-assigned risk levels, with the hypothesis that these approaches would identify distinct populations. Methods: This was a cross-sectional study including NC Medicaid participants aged 0-20 years residing in a five-county region in central NC in October 2022. The NC InCK risk stratification algorithm was used to assign participants to Service Integration Levels (SILs) 1, 2, or 3, reflecting increasing anticipated need for integrated cross-sector support. Descriptive analyses compared participant baseline characteristics by NC InCK and Medicaid MCO risk level. Results: Of 99,564 children, 90,151 (90.5%) were assigned to SIL 1, 5,482 (5.5%) to SIL 2, and 3,931 (4%) to SIL 3. About 24% and 20% of children assigned to SILs 2 or 3 by NC InCK were identified as low risk by their Medicaid MCO. Conclusions: The NC InCK risk stratification approach assigns children to SILs 2 and 3 using health, education, social, and juvenile justice data. These populations differ from those identified by Medicaid MCO risk stratification, suggesting that inclusion of non-clinical variables adds unique value. This approach is a step forward in demonstrating the feasibility of methods that proactively identify populations for preventive support by including upstream risk factors.