Current Projects
Our current work includes:
(1) an examination of current Medicaid and SCHIP financing and
reimbursement strategies to determine their applicability to CYSHCN using
national data and person-level claims and encounter data and policy
recommendations about the best combination of strategies to use when
reimbursing health plans caring for CYSHCN;
(2) an assessment of how financing strategies affect health plans of
different sizes and the enrollment of children with different health care
needs;
(3) the design of financing strategies for children newly enrolling in
health plans;
(4) the development of financing strategies for children who are required
to transfer to a new health plan when their previous plan exits the market;
(5) the design of financing strategies to promote the medical home concept
and to reimburse providers caring for CYSHCN;
(6) the impact of increased cost-sharing on children’s health care use
patterns, families’ out-of-pocket spending, and children’s insurance status;
and
(7) beginning analyses of health care use patterns and expenditures for
adolescents with special needs who are transitioning to the adult health care
system.
We provide technical assistance to four different states and five public and
private health plans. Our assistance concerns such matters as: (a) health-based
risk adjustment strategies for plan and provider reimbursement; (b) financial
incentive programs linking enhanced payments to realized quality of care
measures; and (c) focused assessments of health plan performance related to care
of CYSHCN. This technical assistance has included: (i) face-to-face meetings
with key stakeholders including health plan representatives, medical directors,
providers, and family advocates; (ii) development of quality of care indicator
results and benchmarks for financial incentive payments; (iii) development of
capitation rates and recommendations about the use of health-based risk
adjustment approaches for children receiving Supplemental Security Income (SSI), Temporary Aide to Needy Families (TANF), and SCHIP enrollees; and (iv) hands-on
assistance in developing utilization and expenditure profiles for children in
public and commercial health plans.
We also are collaborating with Family Voices in the development of chart
books and an interactive website about CYSHCN’s health care use and expenditures
and the quality of their health care. We will work with Family Voices to provide
technical assistance about the use of these tools in promoting adequate
financing of health care for CYSHCN.
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