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Published on: January 29, 2014
Care Quality and Spending Among Commercially Insured Children With Disabilities
Alyna T Chien1, Sara L Toomey1, Dennis Z Kuo2
1Division of General Pediatrics, Department of Medicine; Department of Pediatrics, Harvard Medical School.
Insights
Children with disabilities (CWD) represent 4.5% of insured individuals and incur higher healthcare spending. While care quality for CWD is comparable to other groups, improving value requires understanding spending and quality aspects.
Area of Science:
- Pediatric healthcare research
- Health services research
- Disability studies
Background:
- Children with disabilities (CWD) represent a significant population within commercially insured healthcare systems.
- Understanding the prevalence, care quality, and spending for CWD is crucial for improving healthcare value.
- Existing research often lacks a comprehensive comparison across different pediatric health subgroups.
Purpose of the Study:
- To determine the prevalence of CWD in a commercially insured population.
- To compare outpatient care quality and annual health plan spending for CWD against other pediatric groups.
- To identify opportunities for enhancing care value for children with disabilities.
Main Methods:
- A cross-sectional study utilizing Blue Cross Blue Shield Massachusetts data (2008-2012) for 1,118,081 person-years.
- Application of the Children with Disabilities Algorithm and Pediatric Medical Complexity Algorithm to identify CWD and non-CWD subgroups.
- Assessment of 14 quality measures and analysis of paid claims for annual spending.
Main Results:
- Children with disabilities constituted 4.5% of all enrollees.
- Care quality for CWD was comparable to non-CWD subgroups across most measures.
- Annual health plan spending for CWD was significantly higher (median 23%, mean 53%) than for children with complex medical conditions without disabilities.
Conclusions:
- Children with disabilities are prevalent in commercially insured populations and experience higher healthcare expenditures.
- Despite comparable care quality, suboptimal care levels exist for CWD.
- Improving care value for CWD necessitates a deeper understanding of the relationship between higher spending and specific quality aspects.
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.
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