HealthySteps Comprehensive Services and Preventive Care: A Medicaid Claims Analysis.

Abstract

This study examines the association of HealthySteps - a two-generation, team-based pediatric primary care model - on preventive care and healthcare utilization for Medicaid-insured children and mothers, and differences across racial/ethnic groups. This retrospective cohort study used linked HealthySteps and Medicaid claims data to compare 12-month outcomes for children receiving comprehensive services with a matched group of similar Medicaid-insured children and mothers. Data used in this study were collected from 2016-2021 and analyzed from 2022-2026. HealthySteps was associated with higher rates of any well-child visit (89.0% vs. 79.6%), attendance of 6+ well-child visits by 15 months of age (64.2% vs. 54.0%), continuity of care with the same provider (65.3% vs. 52.8%), developmental screening (37.9% vs. 26.9%), and Early Intervention (13.8% vs. 8.9%). HealthySteps was also associated with greater likelihood of an emergency department visit (43.9% vs. 38.7%), though not high ED usage (2+ visits). Compared with their counterparts, preventive care increases associated with HealthySteps were larger for Black, Hispanic, and, to a lesser extent, Asian children than for White non-Hispanic children. Among mothers, HealthySteps was associated with greater family planning services (35.8% vs. 31.6%), maternal depression screening (10.9% vs. 8.8%), postpartum care (29.5% vs. 24.6%), and ED visits (36.1% vs. 33.5%), as well as fewer lactation services (6.9% vs. 9.4%). Improvements in preventive care associated with HealthySteps represent meaningful clinical impact, as timely care in the first three years is crucial for healthy development. The larger gains among Black, Hispanic, and Asian children also highlight HealthySteps potential to mitigate persistent disparities in preventive care receipt.