Medicaid Managed Care and Community Providers: New Partnerships

Health Affairs

Volumn 16, Issue 4, 1997, Pages 91-107

  Lipson, Debra J ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AGED; ARTICLE; COMMUNITY CARE; COST CONTROL; ECONOMICS; FEMALE; FINANCIAL MANAGEMENT; FORECASTING; HEALTH INSURANCE; HUMAN; INFANT; MALE; MEDICAID; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PREGNANCY; SOCIAL WELFARE; SOCIOECONOMICS; UNITED STATES;

ADULT; AGED; COMMUNITY HEALTH SERVICES; CONTRACT SERVICES; COST CONTROL; FEMALE; FORECASTING; HUMANS; INFANT; MALE; MANAGED CARE PROGRAMS; MEDICAID; MEDICAL INDIGENCY; ORGANIZATIONAL AFFILIATION; PREGNANCY; SOCIAL WELFARE; UNITED STATES;

EID: 0346158693     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.4.91     Document Type: Article

References (21)

1. Health Care Financing Administration, "Medicaid Managed Care Enrollment Report" (Washington: HCFA, Office of Managed Care, 30 June 1996).
2. American Association of Health Plans, 1995 HMO-PPO Trends Report (Washington: AAHP, 1995).
3. Other safety-net providers include public and private hospitals, including academic health centers, that serve disproportionate numbers of Medicaid and uninsured patients. This paper focuses on providers that provide only outpatient care.
4. National Association of Community Health Centers, Access to Community Health Care: A National and State Data Book (Washington: NACHC, 1996).
5. C. Orbovich, "Collaborative Strategies for Success in the Changing Medicaid Market The Perspectives of Community-Based Providers and Managed Care Organizations" (Prepared for the Health Resources and Services Administration, U.S. Department of Health and Human Services, April 1996).
6. D. Lewis-Idema and M. Falik, Health Departments and Medicaid Agencies: Is the Cold War Really Over? (Portland, Maine: National Academy for State Health Policy, August 1990).
7. J. Schlitt et al., "School-Based Health Centers and Managed Care: Seven School-Based Health Center Programs Negotiate a Difficult Fit" (Washington: Making the Grade Program, The George Washington University, February 1996).
8. D.J. Zimmerman and C.J. Reif, "School-Based Health Centers and Managed Care Health Plans: Partners in Care," Journal of Public Health Management Practice (Winter 1995): 33-39.
9. Orbovich, "Collaborative Strategies," 21.
10. Lewin-VHI and MDS Associates, Community Health Centers' Performance under Managed Care (Rockville, Md.: Bureau of Primary Health Care, Health Resources and Services Administration, December 1994).
11. Bureau of Primary Health Care, HRSA, "Impact of Changes in the Nation's Health Care System on Safety Net Providers: The Case of Health Centers" (Memorandum from Marilyn Gaston, associate administrator, Bureau of Primary Health Care, HRSA, July 1996). According to the bureau's review of 150 contracts between health plans and federally qualified health centers, an estimated 50 percent do not offer reasonable reimbursement rates (page 18).
12. Some of these lessons appear in the paper by Orbovich, "Collaborative Strategies," 15, and were raised by participants in the meeting sponsored by HRSA and AAHP, "Collaborative Strategies," 1-2 April 1996, in Washington, DC.
13. Some of these lessons appear in the paper by Orbovich, "Collaborative Strategies," 15, and were raised by participants in the meeting sponsored by HRSA and AAHP, "Collaborative Strategies," 1-2 April 1996, in Washington, DC.
14. Under Section 1915(b), states can ask to waive provider "freedom-of-choice" rules to mandate enrollment of Medicaid beneficiaries into managed care arrangements. Under Section 1115, states can ask to waive many rules to conduct research and demonstration projects that advance the objectives of the Medicaid program. Typically, Section 1115 waivers have been granted to allow states to implement mandatory managed care plans on a statewide basis and use the savings to extend eligibility to additional groups of low-income persons.
15. M.S. Sparer, "Medicaid Managed Care and the Health Reform Debate: Lessons from New York and California," Journal of Health Politics, Policy and Law (Fall 1996): 433-460.
16. "California Local Initiatives: Managing Healthcare in the Community," Access (Newsletter of the California Association of Public Hospitals and Health Systems) (Summer 1996): 7.
17. T. Mark et al., Medicaid Managed Care Program Access Requirements, Final Report (Report prepared for the Prospective Payment Assessment Commission, Project HOPE, Center for Health Affairs, Bethesda, Maryland, March 1995).
18. Ibid., 3-2.
19. D.J. Lipson and N. Naierman, "Effects of Health System Changes on Safety-Net Providers," Health Affairs (Summer 1996): 33-48.
20. M. Gold, M. Sparer, and K. Chu, "Medicaid Managed Care: Lessons from Five States," Health Affairs (Fall 1996): 153-166.
21. Ibid., 164.