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

Highlights
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Effective care coordination systems include the following components.
* A multi-disciplinary approach to assessment, care planning, and care
coordination is designed that assigns responsibilities to members of the
team based on individual care needs.
* Procedures for coordinating the medical and social service needs that
involve working with area agencies on aging, developmental and
behavioral clinic services and other community-based programs
appropriate to the population to be enrolled.
* Procedures for identifying and assessing high risk enrollees.
* Steps to coordinate activities when multiple care coordinators are
assigned to a beneficiary by different programs and agencies.
* Recognize and address the multiple variations for participation in
managed care and fee-for-service programs among beneficiaries.
Marketing and Enrollment 22
Effective managed care begins with marketing, outreach and education to
beneficiaries. (Please refer to the chapter on consumer protection in Volume 11 for
more information on enrollment and disenrollment.) <strong>Managed</strong> care works best
when beneficiaries understand their choices and select a plan based on their health
needs and past relationships with a range of health and, if included in the managed
care program, behavioral health and long term care providers. Once a plan is
selected, beneficiaries need to know how the plan operates, what is expected of
members and what members can expect from their plan. A number of activities are
necessary to acquaint beneficiaries with managed care. State agencies, brokers, plans,
advocates, providers and beneficiaries all have roles in outreach, marketing and
education to assure an effective managed care system. Consumer representatives
stress the importance of face to face meetings, rather than mail or phone contact, to
conduct enrollment.
22 Much of the information in this section was derived from: Jane Horvath and Neva Kaye,
Enrollment and Disenrollment in <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong> Program Management, (Portland, ME: National
Academy for State Health Policy, 1996). and Robert L..Mollica, et al., Consumer Protection: Lessons
Learned from States, The Kaiser-HCFA State Symposia Series (Portland, ME: National Academy for State
Health Policy, 1996).
The National Academy for State Health Policy e @ 8/97
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