This project will assess the effects of state policy choices concerning managed care for publicly insured CSHCN. The project is organized around two phases. In the first phase, we will assemble and summarize a unified set of information on state policies concerning the use of managed care in Medicaid and SCHIP for CSHCN. This information will be assembled from existing administrative sources, such as the Center for Medicare and Medicaid Services website, special surveys conducted by the Urban Institute, a database of Medicaid and SCHIP managed care contracts developed by the Center for Health Services Research and Policy at George Washington University, and supplemented with limited primary data collection where necessary. The information will be analyzed to create a typology of managed care program models at two levels of complexity. The typology would incorporate the general structure of the managed care program with respect to how services for CSHCN are organized and financed. For capitated programs, we would create a sub-typology that would incorporate information on the extent to which statutory or regulatory requirements were designed to meet the special service use needs of CSHCN or provide economic incentives to health plans to provide appropriate levels of care for CSHCN. In this way we expect to open the "black box" of managed care measures available for analysis. Information on individual state programs and policies, and the characterization of programs using this typology would provide a unique resource for policy makers and researchers. In the second phase of the project, we will examine the relationship between the different models of managed care and access, use, care coordination, and satisfaction for Medicaid or SCHIP enrolled CSHCN, allowing us to identify program characteristics associated with the best outcomes for CSHCN. We would link the data on Medicaid and SCHIP managed care programs developed in Phase I of the project to the National Survey of CSHCN and to the National Health Interview Survey, both household surveys that include a variety of characteristics of children, as well as measures of access to care, satisfaction, coordination and use of services. Using descriptive and multivariate techniques we will determine whether various outcomes for CSHCN are associated with different managed care program designs.
Listed is descending order by year published.
Davidoff A, Hill I, Courtot B, Adams E. Are there differential effects of managed care on publicly insured children with chronic health conditions? Med Care Res Rev. 2008 Jun;65(3):356-72. Epub 2008 Jan 28.
Davidoff A, Hill I, Courtnot B, Adams E. Effects of managed care on service use and access for publicly insured children with chronic health conditions. Pediatrics. 2007 May;119(5):956-64.
Medicaid SCHIP & Health Insurance,
Special Health Care Needs, Cost Effectiveness, Access to Health Care, Coordination of Services