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

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Sources Kronick R, Dreyfus T. Lee L, Zhou Z: Diagnostic risk adjustment
for <strong>Medicaid</strong>: the disability payment system. Health <strong>Care</strong> Financing
Review. 17:7-33, 1996.
Kronick R, Zhou Z. Dreyfus T: Making risk adjustment work for
everyone. Inquiry. 32:41-55, 1995.
1 4 National Aocyateon of Chidren's Hosptb and Related Institutions'
Purpose Pricing and capitation risk adjustment, prevalence estimates, profiling
utilization and costs
Predictors Diagnosis and functional status
Method Children with congenital and chronic physical, mental, emotional,
behavioral, or developmental disorders -- expected to last 12 months or
longer or 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.
Testing <strong>Medicaid</strong> and commercial health plan data from the state of Washington.
and Use Not yet available for managed care plans.
Strengths * NACHRI is already well along in the development and testing phase
and the classification system will be available in the next few months.
* An extensive review of physical, mental, developmental, behavioral,
and emotional conditions are classified.
* This approach allows for classifying children with multiple chronic
conditions.
Units * The data for this approach is not yet available nor widely tested.
* States and plans are seeking a single classification software package
for all nonelderly populations and may, therefore, not be as interested
in a unique pediatric risk adjustment system.
Source National Association of Children's Hospitals and Related Institutions: New
NACHRJ Classification System To Be Released for Children with Congenital
and Chronic Health Conditions. Alexandria, VA: NACHRI, 1996.
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