Medicaid Managed Care - U.S. Senate Special Committee on Aging
Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging
594 with family and friends, contacts with juvenile and criminal justice, and alcohol and drug use. 13 In addition to any available outcome measures, states monitor quality through such process measures as: * Access - maximum distance to a hospital, maximum time for response to a phone call, maximum wait at an emergency room or for a hospital bed, etc. * Types of providers - children's providers, gerontologists, social service providers, etc. * Ability to serve special needs populations - individuals dually diagnosed with mental illness and substance abuse issues, children in foster care, etc. * Caseload ratios especially with regards to special populations * Quality indicators such as those in HEDIS. In its first bid for mental health managed care, Massachusetts held plans accountable to the measures listed above. Now in its second bidding process, the state has added these criteria: * Length of time the consumer is in the community * Length of time the consumer is in a single living situation which he/she likes x, * Ability of the consumer to participate in school or work (including supported work). Delaware's performance indicators for the Child Mental Health Public/Private Partnership' 4 include: * Effectiveness 13 Robert Cunningham, 'Outcomes Hard to Track in Kids' Behavioral
595 - Client improvements on pre/post symptoms and community functioning - Consumer satisfaction - Low rates of unplanned readmissions, premature discharges, failed transitions Efficiency - Average cost per quintile of population served - Controlled lengths of bed stays, hospital and residential treatment - Cost per admission to deep end services * Appropriateness - Levels of intervention based on levels of severity; judicious use of bed resources - Clients move toward less restrictive levels of care - Parents participate in treatment planning - Treatment team leaders validate selection of level * Accessibility - Services are geographically accessible - Services are equally available across age range - Minority groups are appropriately represented across levels - Service populations represent various disability groups - Follow-on services, e.g., for 17 year olds, are accessible * Provider Capacity - Adequate service capacity in various levels to accommodate inflows - Adequate support for intake/assessment, clinical services management, provider administration - Clients move appropriately between commercial MCOs and public MCO (managed by the Division of Child Mental Health) Using the Data Once goals are in place, specificity of desired results in the procurement and contracting process can keep states in control of the process. However, while an outcome can be specific, the state may not want to spell out the means to that outcome. For example, if reimbursement is limited to only the covered services enumerated, new service development can be slowed or prohibited. States suggested the following contract provisions. * The performance standard expected; (if available) the outcome desired The National Academy for State Health Policy 0 8/97 IV-92
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594<br />
with family and friends, c<strong>on</strong>tacts with juvenile and criminal justice,<br />
and alcohol and drug use. 13<br />
In additi<strong>on</strong> to any available outcome measures, states m<strong>on</strong>itor quality through such<br />
process measures as:<br />
* Access - maximum distance to a hospital, maximum time for resp<strong>on</strong>se<br />
to a ph<strong>on</strong>e call, maximum wait at an emergency room or for a hospital<br />
bed, etc.<br />
* Types of providers - children's providers, ger<strong>on</strong>tologists, social service<br />
providers, etc.<br />
* Ability to serve special needs populati<strong>on</strong>s - individuals dually<br />
diagnosed with mental illness and substance abuse issues, children in<br />
foster care, etc.<br />
* Caseload ratios especially with regards to special populati<strong>on</strong>s<br />
* Quality indicators such as those in HEDIS.<br />
In its first bid for mental health managed care, Massachusetts held plans accountable<br />
to the measures listed above. Now in its sec<strong>on</strong>d bidding process, the state has added<br />
these criteria:<br />
* Length of time the c<strong>on</strong>sumer is in the community<br />
* Length of time the c<strong>on</strong>sumer is in a single living situati<strong>on</strong> which<br />
he/she likes x,<br />
* Ability of the c<strong>on</strong>sumer to participate in school or work (including<br />
supported work).<br />
Delaware's performance indicators for the Child Mental Health Public/Private<br />
Partnership' 4 include:<br />
* Effectiveness<br />
13 Robert Cunningham, 'Outcomes Hard to Track in Kids' Behavioral <str<strong>on</strong>g>Care</str<strong>on</strong>g>,' Medicine and<br />
Health Perspectives (January 20. 1997).<br />
14 Diam<strong>on</strong>d State Health Plan, A Public MCO Innovati<strong>on</strong>: The Rote of the Divisi<strong>on</strong> of Child<br />
Mental Health Services in <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> <str<strong>on</strong>g>Managed</str<strong>on</strong>g> <str<strong>on</strong>g>Care</str<strong>on</strong>g>'s Child Mental Health Public/Private Partnership,<br />
(Delaware Department ot Services tar Children, Youth and Their Families, February 1996).<br />
The Nati<strong>on</strong>al Academy tor State Health Policy * 0 8/97 1V-91
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