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.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01HS009949-01
Application #
2722775
Study Section
Special Emphasis Panel (ZHS1-HSRD-A (02))
Program Officer
Friedman, Bernard
Project Start
1998-07-01
Project End
2001-06-30
Budget Start
1998-07-01
Budget End
1999-06-30
Support Year
1
Fiscal Year
1998
Total Cost
Indirect Cost
Name
University of Florida
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
073130411
City
Gainesville
State
FL
Country
United States
Zip Code
32611