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
610 taken into account considerable commentfrom the States in the course offraming our findings and recommendations. The Acting Assistant Secretary of Health did not comment on the specific findings or recommendations in the report, but did offer four suggestions that could enhance the transition process to
EXECUTIVE SUMMARY 611 TABLE OF CONTENTS INTRODUCTION ........................................... PAGE MANAGED CARE PENETRATION .............................. 3 CHALLENGES AND RESPONSES ............................... 5 Success in Establishing Core Teams ............................. 5 Some Concerns in Acquiring Necessary Knowledge and Skills .... ......... 6 Limited Progress in Instilling New Mission and Culture ................. 7 Minimal Efforts in Redeploying Fee-For-Service Staff .... ............. 10 Danger Signs for Traditional Fee-For-Service Functions .... ............ 11 RETOOLING AS AN ISSUE ........... ....................... 15 RECOMMENDATIONS . .................................... 16 COMMENTS ON THE DRAFT REPORT ...... ................... 19 APPENDICES .............................................. A: Background on
- Page 562 and 563: 560 cannot enroll a person in a Med
- Page 564 and 565: 562 Medicare members are not typica
- Page 566 and 567: 564 Regence HMO Oregon staff noted
- Page 568 and 569: 566 community based organizations t
- Page 570 and 571: 568 Although technical advice for c
- Page 572 and 573: 570 Risk pools are usually used to
- Page 574 and 575: 572 Internal Quality Program Standa
- Page 576 and 577: 574 enrollee utilization patterns,
- Page 578 and 579: 576 that the overall prevalence of
- Page 580 and 581: 578 HMOs with risk contracts must h
- Page 582 and 583: 580 Summary As Medicaid</st
- Page 584 and 585: 582 Chapter 3 Medicaid</str
- Page 586 and 587: 584 carve-out approach: - improves
- Page 588 and 589: 586 Coordinating Medical and Non-Me
- Page 590 and 591: 588 Oregon,8 program planners origi
- Page 592 and 593: 590 Medicaid syste
- Page 594 and 595: 592 Oversight/Monitoring Quality De
- Page 596 and 597: 594 with family and friends, contac
- Page 598 and 599: 596 * The type(s) of data necessary
- Page 600 and 601: 598 * Specificity of desired result
- Page 602 and 603: 600 Initiatives under way may prove
- Page 604 and 605: 602 a estring the services authoriz
- Page 606 and 607: 604 Development of appropriate plan
- Page 608 and 609: 606 OFFICE OF INSPECTOR GENERAL The
- Page 610 and 611: Establishing core developmental tea
- Page 614 and 615: PURPOSE 612 INTRODUCTION Our purpos
- Page 616 and 617: 614 MANAGED CARE PENETRATION The de
- Page 618 and 619: 616 CHALLENGES AND RESPONSES Our re
- Page 620 and 621: 618 > In building up and maintainin
- Page 622 and 623: 620 * For the most part, the agenci
- Page 624 and 625: 622 beginning to look for associate
- Page 626 and 627: 624 challenge will be to ensure tha
- Page 628 and 629: 626 RETOOLING AS AN ISSUE Retooling
- Page 630 and 631: 628 finding effective ways of deali
- Page 632 and 633: 630 COMMENTS ON THE DRAFT REPORT We
- Page 634 and 635: Defining Managed <
- Page 636 and 637: DATE: JU 27 1997 TO: June Gibbs Bro
- Page 638 and 639: 636 protocols will be enhanced thro
- Page 640 and 641: 638 Broad and explicit state health
- Page 642 and 643: 640 APPENDIX C ENDNOTES 1. See, for
- Page 644 and 645: 642 The First Biannual Report of th
- Page 646 and 647: 644 30. In Massachusetts, for examp
- Page 648 and 649: 646 CHILDREN WITH SPECIAL HEALTH CA
- Page 650 and 651: Prface 648 The U.S. Maternal and Ch
- Page 652 and 653: 650 L DEFINING AND IDENTIFYING CHIL
- Page 654 and 655: 2. Child Health Questionnaire (CHQ)
- Page 656 and 657: 654 Limits * This approach identifi
- Page 658 and 659: 656 To what extent does the definit
- Page 660 and 661: 658 II. FAMILY PARTICIPATION IN MAN
EXECUTIVE SUMMARY<br />
611<br />
TABLE OF CONTENTS<br />
INTRODUCTION ...........................................<br />
PAGE<br />
MANAGED CARE PENETRATION .............................. 3<br />
CHALLENGES AND RESPONSES ............................... 5<br />
Success in Establishing Core Teams ............................. 5<br />
Some C<strong>on</strong>cerns in Acquiring Necessary Knowledge and Skills .... ......... 6<br />
Limited Progress in Instilling New Missi<strong>on</strong> and Culture ................. 7<br />
Minimal Efforts in Redeploying Fee-For-Service Staff .... ............. 10<br />
Danger Signs for Traditi<strong>on</strong>al Fee-For-Service Functi<strong>on</strong>s .... ............ 11<br />
RETOOLING AS AN ISSUE ........... ....................... 15<br />
RECOMMENDATIONS . .................................... 16<br />
COMMENTS ON THE DRAFT REPORT ...... ................... 19<br />
APPENDICES ..............................................<br />
A: Background <strong>on</strong> <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> ...... ................... A-1<br />
B: Complete Comments <strong>on</strong> the Draft Report ......................... B-1<br />
C: Endnotes ............................................. C-I