RehabWire - Volume 6, Number 3, April, 2004

RehabWire for April looks at managed care and disability and rehabilitation. How are these services administered under what has become the norm for healthcare?

NIDRR Projects: Research in the New Millennium.

The Consortium for Children and Youth with Disabilities and Special Health Care Needs, Georgetown University (H133B001200) led by Phyllis Magrab, PhD and Larke Huang, PhD. Bonnie Gracer, Project Officer.
Abstract: The Consortium improves rehabilitation outcomes for children and youth with disabilities and special health care needs by increasing the effectiveness of service system. Using an integrated, multifaceted research approach and related training, dissemination, and technical assistance activities, the Consortium targets five areas: (1) access issues in pediatric rehabilitation, (2) characteristics of health plans and access to services, (3) promising practices in transition from pediatric to adult health care, (4) effective telehealth strategies for interdisciplinary service delivery in remote areas, and (5) training issues in Assistive Technology.
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Rehabilitation Research and Training Center for Children’s Mental Health, University of South Florida (H133B990022) led by Robert Friedman, PhD. Bonnie Gracer, Project Officer.
Abstract: This program conducts an integrated set of field research projects, employing multiple methods to examine policies affecting children with emotional disturbances and their families in order to enhance the understanding of policy development, its implementation and effects. The research program builds on an analytic framework for understanding variables related to translation of policy into community-level actions. The consistency of state-level policy with system-of-care principles is examined through a series of related studies that address: family perspectives, interagency collaboration, school reform in urban communities, local theories of change and their relationship to services and outcomes, Medicaid managed care and the State Children’s Health Insurance Program, the impact of managed care and system-of-care policies on access to care for children of color and their families, and development of a new instrument to assess interagency collaboration.
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UIC National Research and Training Center on Psychiatric Disability, University of Illinois at Chicago (H133B000700) led by Judith A. Cook, PhD. David W. Keer, Project Officer.
Abstract: This Center conducts a comprehensive series of research and training projects that focus on increasing self-determination for persons with psychiatric disabilities. The Center’s current projects are composed of five core areas: (1) choices in treatment decision-making; (2) economic self-sufficiency; (3) consumer advocacy under managed care; (4) career development through real jobs for real wages; and (5) strengthening self-determination skills and self-advocacy. These core areas reaffirm that people with psychiatric disabilities have the right to maximal independence, which grows out of making choices in the decisions that affect their lives.
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Xray of arthritic hands. Source: jnatiuk on Stock.xchng

Medicaid Quality Indicators for Individuals with Disabilities, National Rehabilitation Hospital/MRI (H133A030804) led by Susan E. Palsbo, PhD. Ruth Brannon, Project Officer.
Abstract: This project develops and validates health service quality indicators for people with disabilities. The target population to be served is people with disabilities enrolled in managed Medicaid programs. The goal is to develop and field test quality measures for people with disabilities in managed care organizations.
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Personalized Health Care for Individuals with Physical Disabilities: Satisfaction with Services and Outcomes, University of Minnesota (H133G010064) led by Brian Abery, PhD. Dawn Carlson, PhD, MPH, Project Officer.
Abstract: This project demonstrates both the direct and indirect effects of the AXIS approach to health care on the lives of adults with physical disabilities. AXIS Healthcare, a joint venture of Sister Kenny Institute and Courage, Inc., was formed to bring knowledge of physical disability to the application of managed care. When dealing with health issues, people with physical disabilities often find themselves battling not only illness but also the health care system itself; this project works in partnership with persons with physical disabilities to coordinate a high-quality, cost effective network of specialized services spanning the continuum of care.

Did You Know...?
April is National Occupational Therapy Month?
The American Occupational Therapy Association sponsors this month-long celebration of the practice of occupational therapy. This year’s theme is driver safety and community mobility. More information is available at

New Research: Selections from REHABDATA

Beatty, P. W., Kroll, T. (2002) Health care access an obstacle for people with disabilities? NARIC Accession Number: O14712.
Abstract: Presents findings from a study that examined the access to needed health care services for people with cerebral palsy, multiple sclerosis, or spinal cord injury. Participants responded to surveys about their access to care in managed care and fee-for-service health plans and the consequences of delayed or denied access. Results were presented on the Internet on October 2, 2002. Documentation includes transcript of the Web cast , an agenda, abstract, information about the presenters, and survey findings.

Bottle of white pills, spilled. Posted to Stock.xchng by Bubbels

Beatty, P. (2003) Health practices in managed care. In Changing Concepts of Health and Disability Conference Proceedings, March 17-18, 2003; Washington, DC, 28-34. NARIC Accession Number: O15038.
Abstract: Study examines the impact of managed care on the health care experience of people with disabilities. Results identify the threat of reduced access to health care and the opportunity for improved coordination of care. Implications for future research, training, and policy strategies are discussed. This paper was presented at the State of the Science Conference and Policy Forum 2003.

Higgins, C. (2002) Managed care and disability. Research Information on Independent Living, 1(5). NARIC Accession Number: O15138.
Abstract: Paper briefly presents research information on the impact of managed care on people with disabilities. Recent research findings report that: lower-income and elderly patients tend to decline in health with managed care over fee-for-services medical care and that managed care providers and services may not be available in some rural areas.

Jones, G. C. (2003) Rural Medicaid managed care for people with disabilities: Compass points for appropriate health care service delivery. Health Disability Policy Brief. NARIC Accession Number: O14750.
Abstract: Brief discusses challenges associated with providing health care to Medicaid beneficiaries with disabilities who live in rural areas. State officials and health plan personnel were interviewed regarding their experiences with rural Medicaid managed care. Three of the most commonly reported challenges were: (1) recruiting and retaining providers, (2) delivering appropriate healthcare services, and (3) improving the fit between disability and health care service provision. Includes recommendation for state and health plans considering the implementation of Medicaid managed care for people with disabilities.

Hayes, O. E. (Ed.) (2002) Research update: Special Edition, Spring Supplement 2002, 1-24. NARIC Accession Number: O14651.
Abstract: Newsletter presents news of research and projects of the National Rehabilitation Hospital Center for Health and Disability Research (NRH-CHDR). In this issue: (1) researchers develop new tools to make the health care system more responsive to individuals with disabilities, (2) health care disparities among working-age adults with disabilities identified, (3) researchers combine quantitative and qualitative methods to gain in-depth understanding of health care access among people with disabilities, (4) troubles with Medicaid managed care, (5) training and technical assistance needed to assist individuals with disabilities in understanding their rights in coping with discrimination in managed care plans, (6) new tools to assist consumers in using managed health care, (7) new guide to help consumers navigate the HMO grievance and appeals process, (8) two new publications on risk adjustment available online, and (9) fellowship program offers practical research experience.

Vladeck, B. C. (2003) Where the action is really is: Medicaid and the Disabled. Health Affairs, 22(1), 90-100. NARIC Accession Number: J44956.
Abstract: Article describes how Medicaid finances services for people with disabilities. Also discusses implementation of the Supreme Court’s decision in Olmstead v. L. C., which requires states to minimize institutionalization in the care of people with disabilities. Issues concerning the lack of specialized care for individuals with disabilities who are enrolled in managed care programs are discussed.

Block, S. R., Athens, K. Brandenburg, G. (2002) Using performance-based contracts and incentive payments with managed care: Increasing supported employment opportunities for people with developmental disabilities. Journal of Vocational Rehabilitation, 17(3), 165-174. NARIC Accession Number: J44860.
Abstract: Article describes a Colorado managed care organization that developed a performance-based funding system to improve supported employment services for individuals with developmental disabilities. The success of the program is attributed to an incentive-based payment system and the flexibility to negotiate rates for services.

hospital hallway. Posted to Stock.xchng by Bubbels

King, T., Green, B. (2003) Neurogenic bladder in the patient with SCI: Management challenges in the era of managed care. Topics in Spinal Cord Injury Rehabilitation, 8(3), 60-74. NARIC Accession Number: J45150.
Abstract: Article discusses the impact of managed care on the evolution of urologic management of the patient with spinal cord injury. Describes the Marcus Community Bridge Program, a case management approach to following patients after discharge from rehabilitation. Case study demonstrates the effectiveness of the program.

Hocutt, A. M., McKinney, J. D., Montague, M. (2002) The impact of managed care on efforts to prevent development of serious emotional disturbance in young children. Journal of Disability Policy Studies, 13(1), 51-60. NARIC Accession Number: J44269.
Abstract: Report presents findings from a project designed to prevent the development of serious emotional disturbance in young, at-risk children. The project involved (1) classroom interventions, use of multiple services located on school grounds, and provision of case management services to the children and their families, and (2) a qualitative case study of the systemic facilitators of, and barriers to, implementation of the intervention. Articles discusses general and specific findings relating to the impact of managed care on the efforts of the project.

Chan, F., Lui, J., Rosenthal, D., Pruett, S. R., Ferrin, J. M. (2002) Managed care and rehabilitation counseling. Journal of Rehabilitation Administration, 26(2), 85-97. NARIC Accession Number: J43938.
Abstract: Article provides an overview of the impact of managed care on the vocational rehabilitation process. Describes the roles and functions of rehabilitation counselors in managed health care and disability care settings. Professional issues related to rehabilitation and managed care are discussed.