Medicaid Managed Care - U.S. Senate Special Committee on Aging

QUALITY AND OUTCOME MEASURES
TUESDAY, JULY 15, 1997
U.S. SENATE,
SPECIAL CoMMIrrEE ON AGING,
Washington, DC.
The forum met, pursuant to notice, at 9:30 a.m., in the Dirksen
<strong>Senate</strong> Office Building. Ms. Susan Christensen, Public Policy Fellow,
presiding.
OPENING STATEMENT OF MS. SUSAN CHRISTENSEN
Ms. CHRISTENSEN. We have arrived at our third forum in the series
of four. The series is examining issues of managed care for people
with special needs. So far, we have been very excited by the
participation and the caliber of the discussion, and today should be
no exception.
I learned a great deal just through the telephone conversations
we engaged in to prepare for today's topic.
This series of forums came about after the <strong>Committee</strong> held a
hearing about people with chronic conditions who are dually eligible
for <strong>Medicaid</strong> and Medicare. We discovered that significant issues
still need to be resolved when serving people with special
needs in managed care plans. We divided those issues roughly into
four main themes which are the topics of our four forums.
At the first forum, we got a picture of what it means to be a person
with special needs. The theme of the second forum was the
ability of the current managed care industry to deliver health care
effectively to individuals who have a wide variety of specialized
needs.
Today's forum covers quality and outcomes measures. We have
devoted an entire forum to this topic because of its importance and
because there is still so much to do in this area. The industry is
only beginning to adopt patient-oriented standards for health plans
that serve healthy people. Those measures rely on data, averages
and indicators related to acute episodes from which enrollees are
expected to recover.
That is not the situation with the beneficiaries who are the subect
of our forums. Just as they need specialized and frequently
long-term care, these beneficiaries will need specialized assurances
of the quality of that care.
Our panelists will each make a short presentation; then we will
have time for questions and discussion. Please jot down any questions
that come to mind as you listen; Hope has some forms for you
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