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

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Plan and Provider Issues
The capacity to provide effective managed mental health care relies upon a
competent and available network of plans and providers. States need to evaluate
the capacity of plans and providers and set clear goals for them prior to launching
managed mental health care.
Plan and Provider Coordination and Training
States use a variety of approaches in bringing plans and providers together to
address the special needs of <strong>Medicaid</strong> beneficiaries. Realizing the <strong>Medicaid</strong> program
is a public one, some plans recognize if they do not voluntarily share information
regarding best practices, the state can identify and share this information
independently.
For example, New York plans to contract with consumer groups to provide
technical assistance in helping build the capacity of plans and providers and to
encourage them to do business differently. Consumer organizations will also be
contracted to teach plans and providers some creative ways to provide services.
Similarly, Wisconsin's AFDC HMO initiative convenes regional mental
health/substance abuse work groups that include members from their HMOs, BHOs,
substance abuse providers, subcontractors, consumers, counties, and advocates to
discuss the effectiveness of treatments and brainstorm ways to improve. This
information sharing helps assure that the system is continuously improving. It also
gives technical assistance to all plans and providers, in both mental health and
primary care.
Massachusetts requires consumer input at the plan level by requiring each MCO to
have an advisory group made up of consumers and providers. The <strong>Medicaid</strong> agency
also convenes ongoing meetings with the Department of Mental Health,
Department of Medical Assistance, and managed care organizations to discuss
specific indicators such as access, quality, system development, and financing.
Finally, Iowa is developing the capacity to profile providers. These profiles are
shared among providers at monthly provider roundtables and summary
information is made available to the public. The roundtables allow discussions of
provider profiling, consumer and provider satisfaction results, quality assurance
and other current issues, and provide a forum for providers to train other providers
on what does and doesn't work.
States warned that providers working in BHOs need to learn new behaviors. Some
providers are very happy in the new environment; they feel there is an opportunity
to be creative in the delivery of services they did not have in the fee-for-service
The National Academy for State Health Policy* C 8/97 IV-86