This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that they received a written after-visit summary from their child's main provider's office. Caregivers then had to report that the written after-visit summary contained all of the following elements: current problem list, current medication list, drug allergies, specialists involved in the child's care, planned follow-up, and what to do for problems related to the outpatient visit.

This outcome was measured using FECC survey. Caregivers needed to have answered yes to the following question: "Has the main provider created a shared care plan for your child?".

Indicator of use of an age-appropriate well-child visit for children less than or equal to 6 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the Accountable Care Organization (ACO). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Use of an age-appropriate well-child visits for children greater than or equal to 12 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the ACO. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

An indicator of one or more outpatient visits to primary care providers (PCP). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Use of one or more outpatient visits to other mental health specialists besides psychiatrists. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of utilization of emergency department. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of hospitalization for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of follow-up within 7 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of having follow-up within 30 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of hospital readmissions within 30 days after discharge. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control group include any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of readmissions in a year to an indicator that the number was greater than zero.

Indicator of hospitalization for mental illness for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of follow-up within 7 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of follow-up within 30 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Indicator of antidepressant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of use of anticonvulsant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of use of anti-anxiety medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of use of anti-psychotic medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of use of attention deficit hyperactivity disorder (ADHD) medications. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of asthma medications fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Indicator of one or more follow-up visits within 30 days after ADHD (attention deficit hyperactivity disorder) prescription. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Caregivers of children with disabilities, and youth (i.e. patients) with disabilities.

To be eligible to participate, the child (as the participant, OR of the caregiver) must:

1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disable (ABD) status since at least one year before the policy change;
2. Be no more than 18 years of age at the time of data collection; and
3. Have been, at the time of the policy change, at least 14 years of age for youth (patient) focus groups, or 2 years of age for caregiver focus groups.

Caregivers of children with disabilities. To be eligible to participate, the caregiver's child must: 1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disabled (ABD) status since at least one year before the policy change; 2. Be no more than 18 years of age at the time of data collection; and 3. Have been, at the time of the policy change, at least 2 years of age.

Caregivers of children with disabilities who are part of the ACO, and fall into one of three categories: 1) children with ABD status with continuous enrollment since July 2013; 2) children with ABD status with 12 month continuous enrollment as of February 2015; and 3) children who were ABD status as of July 2013 who are no longer eligible for ABD but qualify for Medicaid and are still in the ACO.

Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes any child who was ABD status at any point during August 2011-June 2016; dataset does not include children without ABD status. These are unique participants. They were not consented or considered "enrolled".

Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes children with disabilities on Medicaid under ABD who moved from fee-for-service coverage to non-ACO managed care. Excluded children who enrolled in managed care before the policy change and children not in managed care after the policy change. These are unique participants. They were not consented or considered "enrolled".

Total of all reporting groups

Demographic data for ACO Stakeholder Interviews were not collected. Age was missing for 1 person from the focus groups. Age was missing for 5 persons from the caregiver survey.

We collected 2062 caregiver surveys. For the analyses, we dropped one survey because the participant's demographic data on the caregiver survey did not match medical record data. Because we dropped one survey, the final sample size for analysis was 2061. Did not collect demographic data for the ACO stakeholder interview arm/group.

We did not collect demographic data on our key informants. Ethnicity data are not available for the Claims Data-ACO Sample/Claims Data Control Sample.

We did not collect demographic data on our key informants.

We collected 2062 caregiver surveys. For the analyses, we dropped one survey because the participant's demographic data on the caregiver survey did not match medical record data. Because we dropped one survey, the final sample size for analysis was 2061.

This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that their child visited more than one doctor's office or used more than one kind of health care service in the 12 months prior to the survey date AND were contacted by their care coordinator in the past 3 months. Caregivers then had to respond positively to both of the following two questions: "In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if you had any concerns about your child's health or treatment?" and "In the last 3 months, when the person who helped you with managing your child's care contacted you, how often did he or she ask if your child's health had changed in any way?".

Percentage of participants who reported that their child visited more than one doctor's office or used more than one kind of health care service in the last 12 months and who were contacted by their care coordinator in the past 3 months

This outcome was measured using FECC survey. To be included in the denominator for this measure, caregivers first had to report that they received a written after-visit summary from their child's main provider's office. Caregivers then had to report that the written after-visit summary contained all of the following elements: current problem list, current medication list, drug allergies, specialists involved in the child's care, planned follow-up, and what to do for problems related to the outpatient visit.

To be included in the analysis for this measure, caregivers first had to report that they received a written after visit summary in the past 12 months

This outcome was measured using FECC survey. Caregivers needed to have answered yes to the following question: "Has the main provider created a shared care plan for your child?".

Participants who responded to the question, "Has the main provider created a shared care plan for your child?"

Indicator of use of an age-appropriate well-child visit for children less than or equal to 6 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the Accountable Care Organization (ACO). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

The overall data included children up to 18 years of age; however, only those children less than or equal to 6 years of age were included in the analysis.

Use of an age-appropriate well-child visits for children greater than or equal to 12 years of age according to the Healthcare Effectiveness Data and Information Set (HEDIS) due to the ACO. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Patients who are greater than or equal to 12 years of age

An indicator of one or more outpatient visits to primary care providers (PCP). ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Use of one or more outpatient visits to other mental health specialists besides psychiatrists. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of utilization of emergency department. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of hospitalization for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of follow-up within 7 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children who were hospitalized

Indicator of having follow-up within 30 days after hospitalization. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children who were hospitalized

Indicator of hospital readmissions within 30 days after discharge. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control group include any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of readmissions in a year to an indicator that the number was greater than zero.

Children who were hospitalized

Indicator of hospitalization for mental illness for patients. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children hospitalized for mental illness. Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of follow-up within 7 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children hospitalized for mental illness

Indicator of follow-up within 30 days after hospitalization for mental illness. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children who were hospitalized for mental illness

Indicator of antidepressant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of use of anticonvulsant medication fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of use of anti-anxiety medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of use of anti-psychotic medication. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of use of attention deficit hyperactivity disorder (ADHD) medications. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of asthma medications fills. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of medication fills in a year to an indicator that the number was greater than zero.

Please note that the number of person-year observations is the same for multiple outcomes - as long as a child is enrolled in Medicaid that year, we would have the same number of observations.

Indicator of one or more follow-up visits within 30 days after ADHD (attention deficit hyperactivity disorder) prescription. ACO sample includes any child who was ABD at any point during the study time period enrolled in the ACO. Control sample includes any child who was ABD and who moved from fee-for-service coverage to non-ACO managed care during the study period. Transforms a count of actual number of visits in a year to an indicator that the number was greater than zero.

Children who received ADHD (attention deficit hyperactivity disorder) prescription

Caregivers of children with disabilities, and youth (i.e. patients) with disabilities.

To be eligible to participate, the child (as the participant, OR of the caregiver) must:

1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disable (ABD) status since at least one year before the policy change;
2. Be no more than 18 years of age at the time of data collection; and
3. Have been, at the time of the policy change, at least 14 years of age for youth (patient) focus groups, or 2 years of age for caregiver focus groups.

Caregivers of children with disabilities. To be eligible to participate, the caregiver's child must: 1. Have resided continuously in the region served by the ACO, have been continuously enrolled in Medicaid, and have had Medicaid Aged, Blind, or Disabled (ABD) status since at least one year before the policy change; 2. Be no more than 18 years of age at the time of data collection; and 3. Have been, at the time of the policy change, at least 2 years of age.

Caregivers of children with disabilities who are part of the ACO, and fall into one of three categories: 1) children with ABD status with continuous enrollment since July 2013; 2) children with ABD status with 12 month continuous enrollment as of February 2015; and 3) children who were ABD status as of July 2013 who are no longer eligible for ABD but qualify for Medicaid and are still in the ACO.

Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes any child who was ABD status at any point during August 2011-June 2016; dataset does not include children without ABD status.

Claims and enrollment data from the Ohio Medicaid program from August 2011-July 2016 (23 months before entering ACO, 30 months post); dataset includes children with disabilities on Medicaid under ABD who moved from fee-for-service coverage to non-ACO managed care. Excluded children who enrolled in managed care before the policy change and children not in managed care after the policy change.