Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Source Stein REX. Westbrook LE, Bauman LU: The questionnaire for identifying
children with chronic conditions (QuICCC): A measure based on a
noncategorical approach. Pediatrics (forthcoming).
6. Naional Association of Chidren's Hospitals and Retated Institutions'
Clasifition Snste n (NACHRI)I
Content Children with congenital and chronic physical, mental, emotional, behavioral, or
developmental disorders that are expected to last 12 months or longer, or to
have sequelae that last 12 months or longer. are identified on the basis of
diagnoses. Some 3,700 ICD-9-CM diagnostic codes have been identified and
assigned to body system and condition categories. Severity level and disease
progression are also classified.
Purpose Estimating prevalence, profiling utilization and costs, and pricing and capitation
risk adjustment
Approach Diagnostic and function-based
Testing <strong>Medicaid</strong> and commercial health plan data from the state of Washington. Not
and Use yet available for managed care plans.
Strengths * This approach requires only diagnostic information in the form of ICD-
9-CM codes. Consequently, it may be relatively easy to implement in a
variety of settings as long as diagnostic data are available.
* NACHRI is already well along in the development phase and the
classification system is expected to be available in the next few months.
Limits * This approach was designed to identify children with existing chronic
conditions. It has limited ability to identify those at risk.
* Determining severity and disease progression, particularly among
children with multiple conditions - though criteria based and
statistically tested - may have certain limitations.
Source: National Association of Children's Hospitals and Related Institutions: New
NACHRI Classification System To Be Releasedfor Children with Congetital
and Chronic Health Conditions. Alexandria, VA: National Association of
Children's Hospitals and Related Institutions, 1996.
To evaluate these various identification approaches certain criteria might be applied.
These include inclusivity, validity, reliability, cost, acceptability, availability, and flexibility.
I. Inclusivity
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