Assessing Managed Care For Children With Chronic Conditions

PROLOGUE: Children with chronic illnesses pose special challenges for the managed care plans that treat them. As health plans step up their demands for monitoring patient care, children's needs should not be overlooked in whatever measurement scheme is put to use. The most widely used scheme, the Health Plan Employer Data and Information Set (HEDIS), has many limitations in its applications to populations of children with chronic conditions, but it is the best measure that currently exists. This paper evaluates the strengths and weaknesses of HEDIS as it applies to chronically ill children and offers recommendations for improving it. Karen Kuhlthau is associate director of the General Pediatrics Research Unit at Massachusetts General Hospital (MGH) in Boston. Deborah Klein Walker is the assistant commissioner for the Bureau of Family and Community Health, in the Massachusetts Department of Public Health. James Perrin, a pediatrician, is an associate professor of pediatrics at Harvard Medical School and director of the Division of General Pediatrics at MGH. Laurie Bauman is a professor of pediatrics at the Albert Einstein College of Medicine in New York City. Steven Gortmaker is a senior lecturer in the Department of Health and Social Behavior, Harvard School of Public Health. Paul Newacheck is a professor of health policy and pediatrics in the Institute for Health Policy Studies and the Department of Pediatrics, University of California, San Francisco, School of Medicine. Ruth Stein is a professor and vice-chairman of pediatrics at the Albert Einstein College of Medicine. She also is the school's director of academic affairs. ABSTRACT: This paper reviews opportunities to monitor managed care for children and adolescents with chronic conditions and considers how well the Health Plan Employer Data and Information Set, version 3.0 (HEDIS 3.0), assesses care for these children. We propose four steps to strengthen the applicability of HEDIS to children with chronic conditions: (1) develop methods of identifying and monitoring groups of children with chronic conditions; (2) report HEDIS indicators for these children separately from those for other children; (3) develop and implement consumer and provider surveys that elicit information specific to these populations; and (4) develop specific structure, process, and outcomes indicators for children with chronic conditions.