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A Case-Mix System for Children and Youth With Developmental Disabilities

Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which h...

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Autores principales: Stewart, Shannon L, Celebre, Angela, Head, Michael J, James, Mary L, Martin, Lynn, Fries, Brant E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750751/
https://www.ncbi.nlm.nih.gov/pubmed/33414639
http://dx.doi.org/10.1177/1178632920977899
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author Stewart, Shannon L
Celebre, Angela
Head, Michael J
James, Mary L
Martin, Lynn
Fries, Brant E
author_facet Stewart, Shannon L
Celebre, Angela
Head, Michael J
James, Mary L
Martin, Lynn
Fries, Brant E
author_sort Stewart, Shannon L
collection PubMed
description Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which has led to the development of case-mix systems. The present study sought to develop a new approach to allocate resources among children and youth with intellectual and developmental disabilities (IDD) as part of a system-wide Medicaid payment reform initiative in Arkansas. To develop the system, assessment data collected using the interRAI Child and Youth Mental Health-Developmental Disability instrument was matched to paid service claims. The sample consisted of 346 children and youth with developmental disabilities in the home setting. Using automatic interactions detection, individuals were sorted into unique, clinically relevant groups (ie, based on similar resource use) and a standardized relative measure of the cost of services provided to each group was calculated. The resulting case-mix system has 8 distinct, final groups and explains 30% of the variance in per diem costs. Our analyses indicate that this case-mix classification system could provide the foundation for a future prospective payment system that is centered around stability and equitability in the allocation of limited resources within this vulnerable population.
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spelling pubmed-77507512021-01-06 A Case-Mix System for Children and Youth With Developmental Disabilities Stewart, Shannon L Celebre, Angela Head, Michael J James, Mary L Martin, Lynn Fries, Brant E Health Serv Insights Original Research Limited funding across health and social service programs presents a challenge regarding how to best match resources to the needs of the population. There is increasing consensus that differences in individual characteristics and care needs should be reflected in variations in service costs, which has led to the development of case-mix systems. The present study sought to develop a new approach to allocate resources among children and youth with intellectual and developmental disabilities (IDD) as part of a system-wide Medicaid payment reform initiative in Arkansas. To develop the system, assessment data collected using the interRAI Child and Youth Mental Health-Developmental Disability instrument was matched to paid service claims. The sample consisted of 346 children and youth with developmental disabilities in the home setting. Using automatic interactions detection, individuals were sorted into unique, clinically relevant groups (ie, based on similar resource use) and a standardized relative measure of the cost of services provided to each group was calculated. The resulting case-mix system has 8 distinct, final groups and explains 30% of the variance in per diem costs. Our analyses indicate that this case-mix classification system could provide the foundation for a future prospective payment system that is centered around stability and equitability in the allocation of limited resources within this vulnerable population. SAGE Publications 2020-12-18 /pmc/articles/PMC7750751/ /pubmed/33414639 http://dx.doi.org/10.1177/1178632920977899 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Stewart, Shannon L
Celebre, Angela
Head, Michael J
James, Mary L
Martin, Lynn
Fries, Brant E
A Case-Mix System for Children and Youth With Developmental Disabilities
title A Case-Mix System for Children and Youth With Developmental Disabilities
title_full A Case-Mix System for Children and Youth With Developmental Disabilities
title_fullStr A Case-Mix System for Children and Youth With Developmental Disabilities
title_full_unstemmed A Case-Mix System for Children and Youth With Developmental Disabilities
title_short A Case-Mix System for Children and Youth With Developmental Disabilities
title_sort case-mix system for children and youth with developmental disabilities
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750751/
https://www.ncbi.nlm.nih.gov/pubmed/33414639
http://dx.doi.org/10.1177/1178632920977899
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