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Caring for children with special needs in HMOs: the consumer's perspective
1CAPP Project, Federation for Children with Special Needs, USA.
Managed Care Quarterly
|February 1, 1997
Summary
Health maintenance organizations (HMOs) must offer robust case management and policies for children with chronic illnesses. Providing clear information on support and specialty care access helps families select appropriate HMOs for their child's needs.
Area of Science:
- Pediatric Healthcare Management
- Health Services Research
- Family Support Systems
Background:
- Children with chronic illnesses require specialized care coordination.
- Families face challenges in navigating healthcare systems to find suitable support.
- Health maintenance organizations (HMOs) play a crucial role in providing this care.
Purpose of the Study:
- To outline essential components of case management and policies for pediatric chronic illness care within HMOs.
- To emphasize the importance of accessible information for families selecting healthcare plans.
- To identify actionable steps for health plans to support families with special needs children.
Main Methods:
- Review of existing health plan structures and policies.
- Analysis of family needs and challenges in accessing specialized pediatric care.
- Incorporation of child advocate perspectives on effective support strategies.
Main Results:
- HMOs need integrated case management systems tailored to chronic pediatric conditions.
- Clear communication regarding case management support and specialty care access is vital for family decision-making.
- Collaborative approaches and partnership roles can enhance family assistance.
Conclusions:
- Effective case management and supportive policies are critical for HMOs serving children with chronic illnesses.
- Transparent information empowers families to choose the best HMO for their child's unique health requirements.
- Health plans must proactively implement strategies to assist families navigating complex healthcare needs.