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Acad Pediatr. 2019 Apr;19(3):291-299. doi: 10.1016/j.acap.2018.06.004. Epub 2018 Jun 19.

Care Quality and Spending Among Commercially Insured Children With Disabilities.

Author information

1
Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School. Electronic address: alyna.chien@childrens.harvard.edu.
2
Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School.
3
Division of General Pediatrics, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo, NY.
4
Department of Pediatrics, School of Medicine, University of Colorado Denver, Anschutz Medical Campus , Aurora, Colo.
5
Division of Pediatric Rehabilitation Medicine, Children's Hospital of Pittsburgh; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine , Pittsburgh, Pa.
6
Division of General Pediatrics, University of California San Francisco Benioff Children's Hospital; Division of General Pediatrics, Department of Pediatrics, University of California San Francisco School of Medicine , San Francisco.
7
Division of General Pediatrics, Department of Medicine.
8
Institutional Centers for Clinical and Translational Research, Boston Children's Hospital.
9
Department of Pediatrics, Harvard Medical School; Division of General Academic Pediatrics, Massachusetts General Hospital for Children , Boston, Mass.
10
Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School; Kaiser Permanente School of Medicine , Pasadena, Calif.

Abstract

OBJECTIVE:

To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions.

METHODS:

This cross-sectional study comprised 1,118,081 person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged 1 to 19years old during 2008 to 2012. We combined the newly developed and validated Children with Disabilities Algorithm with the Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups. We used 14 validated or National Quality Forum-endorsed measures to assess outpatient care quality and paid claims to examine annual plan spending levels and components.

RESULTS:

CWD constituted 4.5% of all enrollees. Care quality for CWD was between 11% and 59% for 8 of 14 quality measures and >80% for the 6 remaining measures and was generally comparable to that for non-CWD subgroups. Annual plan spending among CWD was a median and mean 23% and 53% higher than that for children with complex medical conditions without disabilities, respectively; CWD mean and median values were higher than for all other groups as well.

CONCLUSIONS:

CWD were prevalent in our commercially insured population. CWD experienced suboptimal levels of care, but those levels were comparable to non-CWD groups. Improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.

KEYWORDS:

children with disabilities; quality; spending

PMID:
29932986
DOI:
10.1016/j.acap.2018.06.004

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