Assessing Health Costs and Use for Children with Special Healthcare Needs: Analytic Strategy for CCS Administrative Data

More than 70 percent of U.S. child health care resources are committed to the 5 percent of children with the most complex of medical conditions.  Fiscal pressures, reforms to the Medicaid program, and implementation of the Affordable Care Act (ACA) provide opportunities to reduce inefficiencies and to expand access to high-quality subspecialty care for these children. 

Unintentional harm, however, may arise if managed care organizations transfer the care of these children to adult-centered systems of care. Approximately one in seven U.S. children with serious chronic illnesses lives in California, and the California Children’s Services (CCS) is the nation’s largest program providing case management and care coordination for children with serious chronic conditions living at or near poverty.  The CCS dataset is comprised of patient-level data pertaining to all CCS authorized claims, non-CCS authorized claims, and managed care encounters for the years 2007-2011. The dataset includes demographic information, geographic information, provider and hospital location, procedures and pharmaceuticals, data to enable analysis by payer type, and fee for service claim details for more than 300,000 children.  

In partnership with a broad, statewide representation of stakeholders (including policymakers, program administrators, and family advocates), the researchers are applying a rigorous, analytic approach to statewide administrative data to answer the following questions:

1.     What are the population-wide patterns of health care costs and health care use for children with serious chronic illnesses?  What individual, regional, and temporal characteristics are associated with the most costly and preventable health care events?

2.     What quality indicators can be applied to this population?  What policy-relevant factors are associated with regional variations in quality indicators for the care of these children?

Funding:  California HealthCare Foundation