Managed care and children with special health care needs.
Providing care to children with special health care needs within a managed care environment presents special challenges for providers and parents alike. The goal of managed care is to contain costs by encouraging or requiring members to obtain services through a designated network. In managed care programs, children and families may experience limited access to specialized care and services, along with decreased fragmentation inherent in fee-for-service care. For providers, managed care creates financial risk while offering opportunities for acquiring new skills and knowledge. The primary care provider assumes a central role in creating a medical home that links the child and family to a single provider who is an ongoing resource and partner in care. To provide comprehensive, coordinated, family-centered care, the medical home provider must learn about a variety of services available within the community and guide parents in learning how to access the services that meet their child's needs. Pediatric nurse practitioners can play a significant role in ensuring that children receive the most appropriate care.
Rhoades Smucker
J M
JM
Children's Hospital of Pittsburgh, 1054 Blackforest Road, Pittsburgh, PA 15235, USA.
D002648:Child; D002908:Chronic Disease / Q000628:therapy*; D003363:Cost Control; D019988:Children with Disabilities; D020793:Gatekeeping; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D009722:Nurse Practitioners; D010346:Patient Care Management; D014481:United States