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PubMed2003

Prenatal psychosocial needs: differences between a TennCare group and a privately insured group in Appalachia.

The purpose of this study was to determine the prenatal psychosocial needs of a group of women enrolled in TennCare, a Medicaid managed care program designed to cover all otherwise uninsured people in Tennessee, and compare them with privately insured women. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between 14 and 44 years of age and 16 to 28 weeks gestation at three prenatal clinics in East Tennessee. Chi-square analysis revealed that the TennCare enrollees in East Tennessee were significantly more likely to report higher psychosocial needs in pregnancy than the privately insured group. Women enrolled in TennCare had a significantly higher incidence of physical abuse, depressive symptoms, and smoking than the privately insured group. Pregnancy provides a window of opportunity for assessing and intervening with vulnerable women enrolled in Medicaid managed care who report psychosocial problems.

Adolescent↗
PubMed1995

The impact of Medicaid managed care on the public health system in Arizona: case study.

This article examines the impact of a statewide Medicaid managed care program, the Arizona Health Care Cost Containment System (AHCCCS), on the local public health system in Arizona. Based on interviews with current and former state and local public health officials, the authors describe public health concerns with capitated health care delivery systems that rely on gatekeeper systems to control utilization. The authors identified difficulties in gauging the extent of the problem, since neither public health nor managed care systems collect data on use of public health clinics by AHCCCS beneficiaries. Relationships between public health officials and managed care officials are characterized by tensions resulting from differing outlooks about access, eligibility, and the need for preventive health services. The report concludes with recommendations developed by the Association of State and Territorial Health Officials (ASTHO) Primary Care Committee on roles for state health agencies in ensuring development of appropriate managed care delivery systems for vulnerable populations.

Arizona↗
PubMedDate not supplied

Managed behavioral health care: a Medicaid carve-out for youth.

This DataWatch assesses the impact of a public sector-managed Medicaid mental health carve-out pilot for North Carolina youth. Access to, volume of, and costs of mental health/substance abuse services are reported. We compared a pilot managed care program, with an incentive to shift hospital use and costs to community-based services, with usual fee-for-service Medicaid. Aggregate data from Medicaid claims for youth (from birth to age seventeen) statewide are reported for five years. We found dramatic reductions in use of inpatient care, with a shift to intensive outpatient services, and less growth in mental health costs. These findings demonstrate that public sector-managed care can be viable and more efficient than a fee-for-service model.

Adolescent↗
PubMed1994

Mental health under national health care reform: the empirical foundations.

This article reviews research pertinent to mental health services under several U.S. health care reform proposals. Issues examined include the redistributional impact of the inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. It is argued that extending a minimalist model of time-limited benefits, similar to that implemented in most managed care programs, to a national health care insurance plan would perpetuate the current two-class mental health care system.

Cost of Illness↗
PubMed2000

How to identify global markets that are ready for managed care.

As international risk carriers observe increasing medical loss ratios, many have flocked to managed care in an attempt to control medical costs while allowing for the measurement of care leading to improved quality. These same risk carriers often find it difficult to determine which managed care programs will produce the desired effects. However, it is not always clear why American health care concepts do not always produce the desired results in some international markets.

Cost Control↗
PubMed2000

Consumer Assessment of Health Plans Survey (CAHPS) results for Oklahoma managed care Medicaid, 1997, 1998, and 1999.

Consumer satisfaction surveys have become an important source of information for purchasers and consumers of health care and health care organizations themselves. Individuals receiving health care provide valuable information regarding access, use of services, and satisfaction with care that can be used for multiple evaluative purposes. The Oklahoma Health Care Authority has adopted the Consumer Assessment of Health Plans Survey (CAHPS) to measure patient satisfaction for the SoonerCare managed care programs. The Oklahoma Foundation for Medical Quality administered the surveys. The adult and child CAHPS core questionnaires served as the basis for the general surveys in 1997 and 1998. The CAHPS for Children with Special Needs survey results and the Pediatric Adaptation of the CAHPS Behavioral Health Survey results were administered in 1999 for baseline measures. Results indicated an overall increase in consumer satisfaction levels across the two CAHPS core questionnaires. Baseline measures for special needs populations were also established.

Adult↗
PubMedDate not supplied

Integration of data and management tools into the new york state medicaid managed care encounter data system.

The New York State Department of Health has created a data warehouse to analyze and evaluate the Medicaid managed care program. Online query tools and reports, grouping tools such as Diagnostic Related Groups, and measurement tools such as Health Plan Data and Information Set (HEDIS) measures have been incorporated into the data warehouse. Other public health data sets including birth certificate data have also been integrated. The result is a powerful data set that can analyze information quickly and efficiently, with built-in data intelligence. Developed over time, this system can provide states, health insurance companies, and health data consortiums a roadmap on how to implement an integrated data warehouse solution.

Databases, Factual↗
PubMedDate not supplied

Promoting choice: lessons from managed Medicaid.

Drawing on the education, enrollment, and assignment experiences of seven states with mandatory Medicaid managed care programs, this paper finds that the vast majority of enrollees will choose their own health plan if the system is explicitly designed with this in mind (as in Minnesota and Oregon). These experiences provide lessons on ways to 1) align program design with state priorities; (2) increase the level of choice (by coordinating enrollment and eligibility processes, broad-based educational strategies, and personalized attention); (3) improve the quality of choice; and (4) design state contracting processes to support choice and continuity of care.

Community Participation↗
PubMed1995

Breast and cervical cancer screening in a low-income managed care sample: the efficacy of physician letters and phone calls.

A randomized trial was conducted to evaluate the combined impact of a physician reminder letter and a telephone contact on the use of Pap tests and mammograms in a low-income managed care program. Women 40 to 79 years of age who were past due for cancer screening were randomly assigned to an intervention or control group. Medical claims were reviewed after 6 months to determine intervention effectiveness. The odds of receiving all needed cancer screening tests during follow-up were four times higher in the intervention group. Women who reported having to take time off from work to see a doctor had lower odds of getting screened.

Adult↗
PubMed1995

Who will pay for involuntary civil commitment under capitated managed care? An emerging dilemma.

Involuntary civil commitment in managed care settings may create conflicts between providers and payers. Providers may determine that a patient, particularly one who presents a risk to self or others, must be confined beyond the period reimbursed by the payer. Court decisions have upheld clinicians' ethical obligations to provide care in these situations. In addition, civil commitment may be used to shift costs of long-term care to another provider. The author explores these issues and suggests six strategies that providers can use to address them. They include avoiding negotiations with payers over individual patients' care by ensuring that contracts with payers address civil commitment and patients at risk of harming themselves or others, identifying and creating services and social supports to reduce the necessity for commitment and allowing creative use of benefits, adopting formal risk assessment protocols to standardize the process for all patients and and clinicians, conducting research on the use of civil commitment and coercion in managed care settings, ensuring that incentives do not exist in states' Medicaid managed care programs to use civil commitment to shift costs, and holding discussions with treatment staff about the growing encroachment of financial considerations into treatment decisions.

Adult↗
PubMedDate not supplied

Medicaid managed care and the emergency department: the first one hundred days.

Spurred by concerns over increasing costs and variable quality, public and private third-party payors are moving their subscribers into managed care plans. A central feature of many of these plans is coordination of patient care through a primary care provider (PCP). In exchange for easy access to the PCP, patients are expected to limit their use of emergency services for episodic, primary, and urgent care problems. The State of Connecticut has begun a transition from a fee-for-service Medicaid plan into a managed care product. Because many Medicaid patients had freely used emergency services under the fee-for-service arrangement, urban teaching hospital emergency departments rapidly became a focus of efforts to control cost and change care-seeking behavior. The Hartford Hospital Emergency Department (ED) began screening, education, and referral of managed Medicaid patients in the fall of 1995 and recorded experiences with patients, administrators, and health care providers involved in the implementation of the managed care program. The first 3 mo following plan implementation were chaotic and frustrating for all parties, with many difficulties due to an unprepared infrastructure. Changes in ED operations and maturation of the payor and health care provider network eventually resulted in a reasonably smooth system accompanied by reductions in ED visit volumes of at least 15%. Continual evolution of role and goals will be necessary if EDs are to maintain an active presence in a health care system dominated by managed care plans.

Aid to Families with Dependent Children↗
PubMed1998

Impact of Medicaid resources on core public health responsibilities of local health departments in Illinois.

With Illinois' plan to embark on a statewide Medicaid managed care program, the impact of Medicaid resources on core public health responsibilities of local health departments (LHDs) was assessed and found to be substantial. A reduction of $330,000 in core public health activities would likely accompany each $1 million in Medicaid resources lost by these LHDs. Only by actively participating in the planning and implementation of these conversions can public health agencies maintain high productivity and efficiency in addressing core public health responsibilities in their communities.

Budgets↗
PubMed1999

Concurrent treatment of patients with depression in the community: provider practices, attitudes, and barriers to collaboration.

BACKGROUND: In randomized controlled trials, patients with major depression who receive broad-based collaborative treatment by both primary care physicians (PCPs) and mental health providers (MHPs) have better outcomes than patients who receive usual care. However, little is known about the concurrent treatment of patients with depression in the community. This study describes the perceptions of PCPs of the frequency of concurrent treatment in community settings, the degree of collaboration between co-treating providers, and factors associated with greater interaction and collaboration. METHODS: A survey was distributed to a stratified, random sample of 276 eligible family physicians in Michigan. Primary analyses were descriptive statistics (point estimation) of PCP practice patterns. Secondary analyses explored predictors of collaboration with multivariable regression. RESULTS: A total of 162 eligible PCPs (59%) returned the survey. PCPs reported that they co-treated approximately 30% of their depressed patients with MHPs. They made contact with co-treating MHPs in approximately 50% of shared cases; however, provider contact seldom included joint treatment planning. PCPs perceived collaborative treatments to be more problematic when patients were enrolled in managed care programs. In multivariable regression, co-location of MHP and PCP practices (in the same building) was strongly associated with increased interaction and collaboration (P <.001). CONCLUSIONS: Concurrent treatment of depressed patients is common in the community, but these treatments are less interactive and collaborative than the treatment models proven effective in randomized controlled trails. If concurrent treatments are to become more collaborative-with regular contact and effective communication-co-location of practices appears important.

Community Mental Health Services↗
PubMed2004

Reconsidering the motor recovery plateau in stroke rehabilitation.

Termination of motor rehabilitation is often recommended as patients with cerebrovascular accident (CVA) become more chronic and/or when they fail to respond positively to motor rehabilitation (commonly termed a "plateau"). Managed-care programs frequently reinforce this practice by restricting care to patients responding to therapy and/or to the most acute patients. When neuromuscular adaptation occurs in exercise, rather than terminating the current regimen, a variety of techniques (eg, modifying intensity, attempting different modalities) are used to facilitate neuromuscular adaptations. After presenting the concepts of the motor recovery plateau and adaptation, we similarly posit that patients with CVA adapt to therapeutic exercise but that this is not indicative of a diminished capacity for motor improvement. Instead, like traditional exercise circumstances, adaptive states can be overcome by modifying regimen aspects (eg, intensity, introducing new exercises). Findings suggesting that patients with chronic CVA can benefit from motor rehabilitation programs that apply novel or different parameters and modalities. The objectives of this commentary are to (1) to encourage practitioners to reconsider the notion of the motor recovery plateau, (2) to reconsider chronic CVA patients' ability to recover motor function, and (3) to use different modalities when accommodation is exhibited.

Activities of Daily Living↗
PubMed1988

Incantations in the dark: Medicaid, managed care, and maternity care.

Public program reforms in the 1980s have substantially increased the numbers of poor pregnant women potentially eligible for Medicaid coverage. Structural deficiencies in the Medicaid program, together with inadequate arrangements in managed-care plans, however, have not led to generally acceptable levels of maternity care. Demonstration projects indicate that Medicaid can be modified cost effectively to underwrite early, continuous, and comprehensive care delivery. Recommendations are suggested for eligibility guarantees, enrollment safeguards, benefit and treatment protocols, provider recruitment, quality control, and sufficient payment rates to overcome barriers to adequate levels of material health care.

Delivery of Health Care↗
PubMed2006

Addressing tobacco in managed care: results of the 2003 survey.

INTRODUCTION: Although tobacco control activity in the United States during the past several years has increased dramatically, tobacco use continues to have devastating consequences among all age cohorts. METHODS: In November 2003, a survey of tobacco control practices and policies in health insurance plans was conducted by America's Health Insurance Plans' national technical assistance office. The survey was the fourth and final survey conducted as part of the Addressing Tobacco in Managed Care program. Of the 215 plans in the sample, 160 (74%) completed the survey. Collectively, these plans represent more than 60 million members of health maintenance organizations. RESULTS: From 1997 to 2003, health insurance plans have demonstrated increasing use of evidence-based programs and clinical guidelines to address tobacco use. The number of plans providing full coverage for any type of pharmacotherapy for tobacco cessation has more than tripled since 1997. Plans have also shown substantial improvement in their ability to identify all or some of their members who smoke. Similarly, a greater percentage of plans are using strategies to address smoking cessation during treatment for other chronic diseases and after acute events such as a myocardial infarction. CONCLUSION: Despite improvements, important opportunities remain for health insurance plans and other stakeholders to expand their tobacco control activities and transfer the lessons learned to other health problems.

Data Collection↗
PubMed1995

Model for management of services to low income pediatric asthma patients.

The article describes Project Concern, a unique, managed care program of direct assistance for low income, pediatric, asthmatic patients. In cooperation with the St. Louis Chapter, Asthma and Allergy Foundation of America, the program was developed by a hospital social worker in response to a need for cost-effective, coordinated care to a high-risk population. As a result of the success of Project Concern, it is suggested that this model be used for other chronic illness where there is a lack of resources for patients and families who have specialized health care needs.

Ambulatory Care↗