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
658 II. FAMILY PARTICIPATION IN MANAGED CARE A. Problem Statement Over the past twenty years, policymakers. pediatric providers, and families have worked diligently to put the family at the center of care for children with special health care needs and to build family/professional partnerships. Families are concerned as they transition into new managed care arrangements that purchasers and plan administrators may not recognize the important role that they can play in care planning, quality assessment, and policy development. Without strong consumer input from families whose children have special health needs, managed care benefit packages, service authorization rules, quality performance measures, network development, and most importantly, provision of health care services, may wrongly assume that one-size fits all children. While most managed care plans now seek some type of consumer feedback, generally the information gathered does not reflect the particular needs and concerns of children with special health care needs and their families, particularly those from diverse cultural and economic backgrounds. Also, information and education about selecting and using managed care services seldom address the unique issues and concerns of these families. Generic family information and education materials often say little about issues such as care coordination. access to specialty care, appeals processes, dispute resolution policies, family support services, and coordination with other community services. Finally, plan policies and procedures often ignore the specialized needs of this population of children and families. Using parents as liaisons with plan providers is not common and parent support activities are seldom included in plans. In addition, particular issues for children with special health care needs are not adequately represented in planning and decisionmaking. Just as public programs have become more responsive to families and more culturally competent due to consumer input, managed care organizations need the same input and education. 9
659 B. Examples of Current Research and Innovative Approaches Greater family participation in managed care organizations can be accomplished by developing appropriate parent and child satisfaction survey questions, pertinent education and information materials, and collaborative family support initiatives. Several new efforts specifically designed for this population are described below. FAMILY SATISFACTION SURVEYS 1. National
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- Page 642 and 643: 640 APPENDIX C ENDNOTES 1. See, for
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- Page 676 and 677: 674 The Practice Parameters Project
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659<br />
B. Examples of Current Research and Innovative Approaches<br />
Greater family participati<strong>on</strong> in managed care organizati<strong>on</strong>s can be accomplished by<br />
developing appropriate parent and child satisfacti<strong>on</strong> survey questi<strong>on</strong>s, pertinent educati<strong>on</strong> and<br />
informati<strong>on</strong> materials, and collaborative family support initiatives. Several new efforts<br />
specifically designed for this populati<strong>on</strong> are described below.<br />
FAMILY SATISFACTION SURVEYS<br />
1. Nati<strong>on</strong>al <str<strong>on</strong>g>Committee</str<strong>on</strong>g> for Quality Assurance<br />
Title <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> HEDIS<br />
Descripti<strong>on</strong> Potential topical modules for enrollee surveys include overall or<br />
summary measures; member characteristics; enrollment process and<br />
length of enrollment; health status and behavioral risk; use of health<br />
services; access to ambulatory care; access to particular types of<br />
care; wait times; office/clinic resp<strong>on</strong>siveness to ph<strong>on</strong>e calls; access<br />
(language, race/ethnicity, cultural issues); barriers to access;<br />
c<strong>on</strong>venience, safety, and comfort; understanding of managed care<br />
procedures; technical quality of care; quality of care - interpers<strong>on</strong>al<br />
and communicati<strong>on</strong>; quality of customer services; and special topics.<br />
Source Nati<strong>on</strong>al <str<strong>on</strong>g>Committee</str<strong>on</strong>g> for Quality Assurance: <str<strong>on</strong>g>Medicaid</str<strong>on</strong>g> HEDIS.<br />
Washingt<strong>on</strong>, DC: NCQA, 1996. (Request from NCQA, 2000 L<br />
Street, NW, Suite 500, Washingt<strong>on</strong>, DC 20036; Ph<strong>on</strong>e 202-955-<br />
3500.)<br />
2. Agency for Health <str<strong>on</strong>g>Care</str<strong>on</strong>g> Poic and Research<br />
Title C<strong>on</strong>sumer Assessments of Health Plans Study (CAHPS)<br />
10