MONITORING AND EVALUATING MANAGED CARE FOR CHILDREN WITH CHRONIC ILLNESSES AND DISABILITIES

Objective. Children with chronic illnesses and disabilities are increa singly enrolling in managed care arrangements. Yet, the rapid expansio n of managed care has unknown consequences for children with chronic c onditions and disabilities. As managed care is likely to become the pr edominant mode of medical practice for children with chronic health pr oblems, information gained from a thorough assessment of existing mana ged care models could be helpful in indicating adjustments and modific ations that could result in improved outcomes for this population. The purpose of this article is to outline a new strategy for collecting n eeded information on the effects of managed care on children with chro nic health problems. Methods. We reviewed the literature on the effect s of managed care on children with chronic conditions and disabilities . We identified key domains relevant to monitoring and evaluating mana ged care for this population. Results. Two research approaches can pro vide helpful information for assessing the effects of managed care on children with chronic conditions. First, a monitoring strategy could b e pursued in which enrollment trends in managed care, enrollee percept ions of access and satisfaction with care, and other general indicator s of outcomes would be tracked over time using inexpensive and rapid t urnaround data sources. Second, an evaluative strategy could be pursue d using experimental or quasiexperimental designs, in which outcomes a cross a variety of domains for children with chronic conditions in man aged care are compared with: (a) outcomes for the same children before enrollment in managed care; or (b) outcomes for similar children rema ining in traditional fee-for-service settings. Evaluation and monitori ng strategies should focus on outcomes in a number of domains includin g: (1) access to care; (2) utilization of services; (3) quality of car e; (4) satisfaction with care; (5) expenditures for care; (6) health o utcomes; and (7) family impact. Conclusion. Assessing outcomes that re sult from enrollment in managed care for children with chronic health problems presents a formidable challenge. The research strategy outlin ed in this article presents one approach to meeting that challenge. Th e monitoring and evaluation strategies described here would require co mmitment of additional resources on the part of government, private fo undations, and/or health plans. Given the paucity of existing informat ion and the stakes for children with chronic conditions and their fami lies, investment of added resources in a comprehensive monitoring and evaluation strategy is essential.