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Improving care coordination for children with disabilities through an accountable care organization
Investigator (PI): Song, Paula
Performing Organization (PO): (Current): University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management / (919) 966-7350
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2019
Record Source/Award ID: PCORI/IHS-1310-07863
Funding: Total Award Amount: $1,962,737
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: What will be studied? Children with disabilities have complex health care needs requiring multiple providers in multiple locations. The lack of coordinated care for this vulnerable population leads to poorer outcomes, higher costs, increased stress, and time demands for patients and their caregivers. Traditionally under arrangements known as fee-for-service, there have been no financial incentives for providers to coordinate care; however, the Affordable Care Act is changing that. Accountable care organizations (ACOs) are groups of health care providers that organize in new ways to take responsibility for the care of a defined population. ACOs share in any savings associated with improved quality and efficiency of the care they provide. While most ACOs currently do not cover children with disabilities, many are considering adding these to the populations they serve. Yet we know little about effectiveness of the care coordination strategies they employ on children with disabilities. What will be compared? The goal of this research is to assess care coordination for and patient-centered outcomes of children with disabilities under an ACO as compared to traditional fee-for-service plans. We will use a recent policy change in Ohio that mandates children with disabilities move from traditional fee-for-service Medicaid plans into managed care arrangements such as ACOs. This mandate resulted in 8,000 disabled children automatically becoming part of the nation's largest pediatric ACO. We will use multiple methods, including focus groups, interviews, a survey, medical record data, and Medicare claims, to compare patient experiences and care under the ACO with experiences and care under the previous fee-for-service model. What impact will this research have? Our research will inform ACOs about the relative benefits and challenges of coordinating care and improving the health outcomes of children with disabilities and will help those organizations determine whether or not they can adequately serve the needs of this population. In addition, the findings will provide patients and caregivers with valuable information that can help them make decisions when faced with an increasingly common scenario, for example, "The parents of a child with cerebral palsy receive a letter from their state Medicaid program that children are being enrolled in an 'accountable care organization.' How certain can they be that their child's care will be improved? What are the problems that might occur?" How will patients and stakeholders be engaged? We will engage patients, their caregivers, and health system stakeholders throughout the research process. Patient advocates have been involved in the design of our study. A patient advisory panel comprised of caregivers and advocates of disabled children will guide our project by providing advice at quarterly meetings. In addition, we will collect data from over 2,800 patient voices through direct study participation.
MeSH Terms:
  • * Accountable Care Organizations
  • Caregivers
  • Cerebral Palsy /economics
  • /therapy
  • Child
  • Comparative Effectiveness Research
  • Disabled Persons
  • Health Policy
  • Humans
  • Medicaid /*economics
  • Ohio
  • Outcome Assessment, Health Care
  • Patient-Centered Care
  • Program Evaluation
  • Quality of Health Care
  • United States
  • Vulnerable Populations
Country: United States
State: North Carolina
Zip Code: 27599
UI: 20152230
CTgovId: NCT02304380
Project Status: Completed
Record History: ('2017: Project extended to 2018.',)