Stewart SL, Celebre A, Head MJ, James ML, Martin L, Fries BE. A Case-Mix System for Children and Youth With Developmental Disabilities.
Health Serv Insights 2020;
13:1178632920977899. [PMID:
33414639 PMCID:
PMC7750751 DOI:
10.1177/1178632920977899]
[Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
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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