Medicaid Managed Care - U.S. Senate Special Committee on Aging
Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging
818 Of the 24 families asked, 13 participated. Refusals were primarily based on a family's inability to make the required time commitment. The Parent Survey The project team made an intensive study of 35 families having a child with a chronic condition through the administration of an in-home parent questionnaire. Forty-four families, each with a child meeting the same criteria as the above, were randomly invited to participate. Those serving on the Parent Advisory Council were exciuded. Thirty-five families agreed to participate for an overall response rate of 80%. The parent survey group is predominantly mid-upper income, college educated, European American. Participants in Parent Survey By Condition & Age Diagnosis Age 1-4 yrs Age 5-11 yrs Age 12-20 yrs Cystic Fibrosis 2 2 2 Cerebral Palsy 2 2 2 Trisomy 21 2 2 2 (Down syndrome) Muscular Dystrophy 1 1 1 Juvenile Onset 1 1 1 Diabetes Mellitus Myelomeningocele 2 2 2 Autism 2 1 1 Blind/Deaf 2 TOTAL: 12 13 11 Children with Disabilities. Families and
The Pediatrician Foilig say the p-imwry ZeI d ossWri8m ti wt dlildren and fadses. D,. Stamb has ban Bnrms pedist-n sdn 1986. Page 1 0 819 Utilization & Cost Data Utilization and cost data on children with representative diagnoses, as well as the most expensive children in the HealthPartners system, was obtained and analyzed. The data represent all the claims to which the HealthPartners information system had access. The study identified all children (a total number of 410) who had been HealthPartners members continuously from November 1,1993, and October 31,1994, who were between the ages of one year and 21 years-of-age and who were identified with the diagnosis of cystic fibrosis, cerebral palsy, muscular dystrophy, juvenile onset diabetes mellitus, congenital heart disease, autism, trisomy 21 (Down syndrome), myelomeningocele and deaf/blind.' The services provided to these children and their families were grouped into 16 categories: hospitalizations, HealthPartners professional visits, out-of-plan professional visits, mental health HealthPartners visits, emergency room visits, HealthPartners urgent care visits, lab/diagnostic services, pharmacy, durable medical equipment, physical therapy, occupational therapy, speech, home health, and other. Denied claims or services received outside of HealthPartners and not billed to HealthPartners (e.g., school, 'The diagnoses of deaf/blind had to be dropped becase they could not be comedly identified by the current infornotion system ;XPAVe New Pa eAsp.:
- Page 770 and 771: 768 (6J identify and evaluate a men
- Page 772 and 773: 770 This paper highlights children'
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- Page 778 and 779: BAZELON CENTER RESOURCES ON MANAGED
- Page 780 and 781: ivn58ffR1eL_ 778 THF VARIAI LITY OF
- Page 782 and 783: _4 What are the essential benefits
- Page 784 and 785: WHAT PUBLIC PURCHASERS CAN DO - Oen
- Page 786 and 787: ASSESSMENT OF STANDARDS - Quality M
- Page 788 and 789: Accessibility, Availability, Referr
- Page 790 and 791: - Credentialing and Recredtentialin
- Page 792 and 793: Standards for Members' Rights and R
- Page 794 and 795: Preventive Behavioral Health Servic
- Page 796 and 797: 9b4 etfJovrk9imut July 16, 1997 794
- Page 798 and 799: hel,4Neipaork SEmi July 16, 1997 79
- Page 800 and 801: 798 Principles for Accountable <str
- Page 802 and 803: 800 The Coalition for Accountable <
- Page 804 and 805: 802 Principles for Accountable <str
- Page 806 and 807: Im. Community 804 Health plans shou
- Page 808 and 809: 806 4. participating in community p
- Page 810 and 811: 808 5. give patients opportunities
- Page 812 and 813: 810 aRve New Children With Disabili
- Page 814 and 815: Table of Contents 812 Executive Sum
- Page 816 and 817: 814 combination of HealthPartners d
- Page 818 and 819: Introduction 816 F amilies whose ch
- Page 822 and 823: 820 Shriner's Hospital, or claims s
- Page 824 and 825: 822 Major Child and Family Concerns
- Page 826 and 827: Services and Funding Sources 824 Nu
- Page 828 and 829: Physician Survey 826 M ost physicia
- Page 830 and 831: 828 Discussion and Recommendations
- Page 832 and 833: 830 * Claims and billing informatio
- Page 834 and 835: 832 El Advocate for a safety net of
- Page 836 and 837: 834 :i:PTNG F'AITH SYMThMr -"r W, M
- Page 838 and 839: 836 We recognize that managed care
- Page 840 and 841: due to a host of complex demographi
- Page 842 and 843: affect many different facets of an
- Page 844 and 845: state agencies, must be held accoun
- Page 846 and 847: In selecting managed care entities
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- Page 850 and 851: plans were virtually identical in b
- Page 852 and 853: to chronically i persons has been t
- Page 854 and 855: Managed Risk Medic
- Page 856 and 857: the lead. Large purchasers might wo
- Page 858: ISBN 0-16-055952-9 9 [ 10111111 155
818<br />
Of the 24 families asked, 13 participated. Refusals were<br />
primarily based <strong>on</strong> a family's inability to make the required<br />
time commitment.<br />
The Parent Survey<br />
The project team made an intensive study of 35 families<br />
having a child with a chr<strong>on</strong>ic c<strong>on</strong>diti<strong>on</strong> through the<br />
administrati<strong>on</strong> of an in-home parent questi<strong>on</strong>naire.<br />
Forty-four families, each with a child meeting the same<br />
criteria as the above, were randomly invited to participate.<br />
Those serving <strong>on</strong> the Parent Advisory Council were exciuded.<br />
Thirty-five families agreed to participate for an overall<br />
resp<strong>on</strong>se rate of 80%. The parent survey group is<br />
predominantly mid-upper income, college educated,<br />
European American.<br />
Participants in Parent Survey<br />
By C<strong>on</strong>diti<strong>on</strong> & Age<br />
Diagnosis Age 1-4 yrs Age 5-11 yrs Age 12-20 yrs<br />
Cystic Fibrosis 2 2 2<br />
Cerebral Palsy 2 2 2<br />
Trisomy 21 2 2 2<br />
(Down syndrome)<br />
Muscular Dystrophy 1 1 1<br />
Juvenile Onset 1 1 1<br />
Diabetes Mellitus<br />
Myelomeningocele 2 2 2<br />
Autism 2 1 1<br />
Blind/Deaf 2<br />
TOTAL: 12 13 11<br />
Children with Disabilities. Families and <str<strong>on</strong>g>Managed</str<strong>on</strong>g> <str<strong>on</strong>g>Care</str<strong>on</strong>g><br />
Parent Survey<br />
Part iipaits iialved in the sirrsey<br />
teee raiidaly selected. Thesefads<br />
had childirs asgisg im ge fr om ae<br />
year to 20 years old twiths aswiety of<br />
cosditias.<br />
The diagnosis set o cystic fibrosis,<br />
cerebral palsy, - lscidar dystrophy,<br />
jaowdei <strong>on</strong>set diabedts ,ellitos,<br />
coagemitl heart disease, autios<br />
teisny 21 (Dosm syndrome),<br />
syelosseiigo-ele, blindiess asd<br />
drasfsst -is chases to represent the<br />
spectrs of chraic illass im<br />
childhood.<br />
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