Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. Planning Grant: Services for Children with Chronic Illness and Disease in an HMO

11/01/1996

Barbara E. Staub, M.D.
Barbara Staub has been at the White Bear Lake Clinic for 13½ years and enjoys her practice. As a general pediatrician, she sees a wide range of illness as well as doing a lot of preventive, well-child care. Dr. Staub's special interests are in chronic illness and disability.

Dr. Staub received her medical degree at the Albany Medical College in 1980. She did her pediatric internship and residency at the University of Minnesota Medical School and was board certified in 1986. Her other professional activities have been a Clinical Assistant Professor, Department of Pediatrics, University of Minnesota Medical School; and Fellow, American Board of Pediatrics.

A COLLABORATIVE PROJECT

  • PACER Center
  • University of Minnesota
  • HealthPartners

STUDY OBJECTIVES

  • Comprehensive assessment of the needs and services, and the costs of services for a pediatric population with chronic illness and disability in a managed care environment.
  • Examine the interface between our managed care system and education and social services.

STUDY COMPONENTS

  • Parental Evaluation
  • Cost and Utilization Data
  • Primary Care Physician Survey
  • Community Advisory Board

PARENTAL ASSESSMENT

  • Family Advisory Board
  • Family Interviews

PARENT ADVISORY BOARD

  • Case Management Services Desired
  • Mental Health Services Desired
  • Information Source About HP Policies Desired

PHYSICIAN SURVEY

  • 29 Physicians Surveyed
  • Time
  • Benefits
  • Care Coordination

COMMUNITY ADVISORY COUNCIL

  • Case Management
    • Agency's Perspective
    • Family Perspective
  • Improved Communication Between Agencies and Health Systems
  • Monitoring of Short and Long-Term Outcomes
  • Monitoring of Costs

HEALTHPARTNERS PROVIDES

  • Access to Subspecialist Care
  • Medical Care Management by Pediatrician
  • Benefits which are Supplemented by other Sources

NEXT STEPS

  • Provide Family-Centered Case Management
  • Address Mental Health Needs
  • Provide Comprehensive Assessment of Total Costs
  • Create Outcome Measures
  • Provide Coordination among Agencies Involved in these Children's Lives
TABLE 1. The Sample by Condition and Age
Diagnoses Ages 1-4 years Ages 5-11 years Ages 12-20 years
Cystic Fibrosis 2 2 2
Cerebral Palsy 2 2 2
Trisomy 21 2 2 2
Muscular Dystrophy 1 1 1
Juvenile Onset Diabetes Mellitus 1 1 1
Myelomeningocele 2 2 2
Autism 1 1 1
Blind/Deaf   2  

 

TABLE 2. Demographics Data
Ethnicity N %
White 33 94.3
Hispanic 1 2.9
Other 1 2.9
Parent Education    
Vocational School 3 8.6
Some College 14 40.0
College 12 34.3
Graduate 5 14.3
Family Income    
$20,000-40,000 13 37.1
$40,000-70,000 15 42.9
$70,000+ 7 14.3

 

TABLE 3. Impact: Does Child's Condition Affect Ability of Parent to be Employed?
Response N %
No 25 71.4
Yes 10 28.6

 

TABLE 4. Supplemental Funding/Insurance Source
Funding Source Yes (receive) No (did not receive)
TEFRA 19 (54.3%) 16 (45.7%)
SSI 4 (11.4%) 31 (88.6%)
Medicaid 4 (11.4%) 31 (88.6%)
Vocational Rehabilitation 4 (11.4%) 31 (88.6%)
WIC 3 (8.6%) 32 (91.4%)
Family Subsidy 2 (5.7%) 33 (94.2%)
Title V - 35 (100%)
AFDC - 35 (100%)

 

TABLE 5. Services Received and Payment Source
Service # Received Payment Sources*
(N) HP TEFRA School Other
OT 19 3 3 16 1
PT 15 5 4 10 1
Speech and Language 13 - 4 10 1
Skilled Nursing 3 1 2 1 1
Personal Care Attendant 12 - 7 2 4
Respiratory Therapy 6 3 2 1 -
Mental Health 2 2 - - -
Medication 28 24 11 - 21
DME 12 9 6 - 8
*Many families receive more than one payment source.

 

 

 

 

 

 

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