Project Description:
Health Care Coordination for Individuals with Physical Disabilities: Critical Elements and Consumer Outcomes - Abstract
The University of Minnesota's Research and Training Center on Community Living proposes a line of research to create new knowledge about health care coordination within Minnesota's Special Needs Basic Care program. Project activities include establishing and testing an operational definition of health care coordination for adults with physical disabilities and examining the extent to which the various components of health care coordination enhance access to health care, improve health outcomes, and create cost savings. The proposed research will build on two previous studies evaluating care coordination models in three managed care programs for Minnesota seniors (Malone, Morishita, Paone, & Schraeder, 2004; Johnson, Ripley, Nwoke, Malone, Morishita, & Paone, 2007) and a previous evaluation examining outcomes of managed care enrollment for adults with physical disabilities in the Minnesota Disability Health Care options (MDHO) program (Abery, Simunds, & Cady, 2006).
Minnesota's Special Needs Basic Care program (SNBC) began enrolling participants in January 2008. By July 2008, 2,273 adults, including a large number with physical disabilities had enrolled in an SNBC product offered by one of seven managed care organizations. SNBC is a voluntary program that combines Medicare and Medicaid financing and services for people ages 18 through 64, who have a disability and are eligible for Medical Assistance, with or without Medicare. Special Needs BasicCare (SNBC) health plans are managed care organizations (MCOs) that have entered into a contract with the Centers for Medicare and Medicaid Services (CMS) to provide Medicare Parts A, B, and D services and participate in Medicare Advantage as a Dual Eligible Special Needs Plan (SNP). If an enrollee is Medicare eligible, the SNBC plan covers all Medicare services including prescription drugs, and any alternative services the health plan may choose to offer. SNBC plans must provide risk screening, medical home, facilitation of annual physician visits, care coordination, broad access to specialists, and extended health related case management. While care coordination is a contractual requirement, the seven plans vary considerably in their implementation strategies.
The project will use several research methodologies to examine care coordination models and outcomes. A Participatory Planning and Decision Making process and key informant interviews will first be used to identify, classify, and richly describe care management models used in SNBC as well as the critical components of effective care coordination. Cognitive testing, and reliability and validity assessment will then be used to modify several instruments to measure the elements of managed care, and managed care outcomes for persons with physical disabilities. Finally, a combination of survey research (in-person interviews) and analysis of secondary data sets (Centers for Medicaid and Medicare utilization information, and Minnesota Department of Human Services assessment and utilization data) will be used to examine managed care outcomes for a total of 400 individuals participating in the SNBC program. Multivariate analyses will be employed to take into account variables such as type and severity of disability (including the presence of dual diagnoses), urban or rural location, age, and other demographic characteristics known or hypothesized to be associated with health care access, outcomes and costs. The impact of care coordination models will be tested on several outcomes including health care access (Health Care Quality Scale, annual DHS mandated health care accessibility survey results), outcomes (including but not limited to health care self-direction, stress, disability impact), and costs. Products from this line of research will include an operational definition of the elements of care coordination, validated reliable instrumentation to measure elements of care coordination, and academic and research to practice publications describing the impact of care coordination on access to health care, health care outcomes and cost.
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Geographic Areas, Rural/Remote, Urban, Specific Groups
