QUALITY OF CARE FOR CHILDREN WITH SPECIAL NEEDS IN MC

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Many concerns have been raised that children with special health care needs (CSHCN) will face restricted access to care when enrolled in managed care plans where health care use, costs, and speciality use are strictly controlled, potentially resulting in adverse health outcomes. These concerns are largely based on anecdote and the effect of managed care on the quality of care for CSHCN is unknown. The primary aim of the proposed research is to assess the effect of selected organizational features of nine different managed care organizations on the processes and outcomes of care for children with special health care needs. These nine MCOs are participating in the Florida Healthy Kids Program, a statewide initiative designed to provide coverage to uninsured children who are not Medicaid eligible and whose parents cannot afford private insurance. Secondarily, the processes and outcomes of care for CSHCN who are enrolled in the Florida Medicaid Program or in one of five different commercial MCOs will be assessed. Because CSHCN often require services from multiple providers, those MCO organizational features that are likely to have the greatest impact on the children s access to pediatricians and specialists and on care coordination for the children were selected for study inclusion. The following organizational features are included in the proposed research: 1. Characteristics of the provider network; 2. The use of prior authorization procedures for speciality referrals, 3. Presence and type of disease management programs, and 4. The ownership status of the MCO. Quality of care will be assessed for children with asthma, diabetes, and CSHCN with varying conditions aggregated by their functional status. The following outcomes of care are included: health care use and expenditures, specialty health care use, health status, missed school days, and restricted activity days. Some disease-specific outcomes also are included. The research design is a quasi-experimental design, with data collected prospectively over a two year period. To conduct this study, we will use rich data sets covering a range of CSHCN who are enrolled in diverse managed care arrangements. These data sets include person- level health care use and enrollment data supplemented with telephone survey and medical record review information about the children s health and functional status.