Most children are healthy and consume relatively few health care resources. However, adolescents (ages 12 through 18) are particularly at risk for increased morbidity and mortality from a variety of causes including special health care needs and consequences of risky behaviors. Their increased need for health care services may place insurers and health care providers at financial risk, particularly within capitated managed care arrangements. Because current capitation rate setting approaches do not sufficiently account for enrollees’ health status, insurers and health care providers may receive inadequate reimbursement when caring for adolescents. To address this issue we have 1. conducted comparative analyses of the effectiveness of five major diagnostic-based risk adjustment systems in predicting adolescents’ concurrent and future health care use and charges for six categories of use: 1. total, 2. outpatient, 3. inpatient, 4. emergency room, 5 intensive care, and 6. use of physician specialists. We have conducted these analyses for overall populations and several subgroups of adolescents, those who have special health care needs, and those with risky behaviors. Our study included adolescent Medicaid enrollees, low-income adolescents enrolled the Florida Healthy Kids Program, and adolescents covered through the State’s Title V agency, Children’s Medical Services. Results indicate that all of the diagnostic-based risk adjustment systems improve prediction of health care use and charges compared to the use of demographic adjusters alone. There are several risk adjustment systems that perform better with groups of generally healthy adolescents, while others are more useful when applied to specific sub-populations of adolescents.
Learning Objectives: During this session, the presenters will describe the application of diagnostic-based risk adjustment systems to populations of low-income adolescents
Keywords: Adolescent Health, Health Care Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.