Michigan recently implemented a voluntary managed care plan for Children with Special Health Care Needs. From the child/family perspective, a CSHCN managed care plan should ensure the same or better access to health services as the traditional fee-for-service CSHCN program. From the managed care contractor perspective, utilization of services under managed care must be as or more efficient than the fee-for-service levels in order to maintain financial viability. The proposed study seeks to investigate the impact of Michigan's managed care program in three areas of fundamental importance to the future viability of such programs: differences in children's utilization of services in a fee-for-service vs. managed care setting; differences in the costs of these services under these two systems of care; and families' and physicians' appraisals of the services they receive or provide under one system vs. another. The study will incorporate four phases of research. Phase 1 calls for the analysis of state CSHCN encounter data to calculate baseline utilization patterns for children with one of 12 common CSHCN qualifying diagnoses. Baseline data will reflect the three-year period (1996-1998) prior to implementation of CSHCN managed care. Phase 2 involves analysis of CSHCN managed care encounter data to calculate utilization and costs for managed care enrollees for the initial two years of the plan (1999-2000), focusing on the same 12 qualifying diagnoses. Managed care utilization and cost data will be compared with similar data from the fee-for-service population during the same time period. In addition, individual pre-post analyses will compare the utilization of individual children who transfer into the managed care plan with their own utilization from previous years in the fee-for-service system. In Phase 3, services authorized under managed care enrollees' Individualized Health Care Plans (IHCPs) will be compared with actual utilization by the same patients, as well as with baseline utilization patterns. Phase 4 involves mailed surveys of parents of CSHCN, to include both managed care and fee-for-service participants. For managed care participants, survey items will explore parents' satisfaction with the plan, including completion of the IHCP, coordination of care, and access to services within and beyond the scope of the IHCP. For fee-for-service participants, survey items will explore the coordination of care in the absence of IHCPs and parents' experiences seeking prior authorization of services. A concurrent survey of CSHCN managed care providers will explore their use of IHCPs, their administrative experience with both CSHCN arrangements, and their perceptions of changes brought about by CSHCN managed care. In total, the three phases of research will allow us to better describe the structure and delivery of services under CSHCN managed care, to understand the extent to which CSHCN managed care facilitates or constrains access to health services, and to assess the economic impact of implementing a managed care plan for this population.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZHS1-SRBB-D (02))
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Brach, Cindy
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Michigan Public Health Institute
United States
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