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

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686 MANAGED CARE EXPERT WORK GROUP ON CAPITATION AND RISK ADIUSTMENT I) Ellis RP, Pope CC. lezzoni U. Ayanian 1Z. Bates DW. BuDstin H. Ash AS: Diagnosis-based risk adjustment for Medicare capitation payments. Healh <strong>Care</strong> Financing Reiew. 17:101-128. 1996. 2) Fowler El. Anderasn GF: Capitation adjustnent for pediatric populations. Pediatr'cs. 98:10-17, 1996. 3) Kronick R. Dreyfiss T. Lee L. Zhou Z: Diagnoetic risk adjustment for <strong>Medicaid</strong>: the Disability Payment System. Heath <strong>Care</strong> Financing Review. 17:7-33. 1996. 4) Kronick R. Zhou Z. Dreyfus T: Making risk adjustment work for everyone. Inquire. 32:41-55. 1995. 5) <strong>Medicaid</strong> Working Group: Risk-Adjtsted Reintsbursetntfor People with Disaihides: A Diagnoact Approach Pmoposed for Missouri. Boston. MA: <strong>Medicaid</strong> Working Group, 1995. (Request from <strong>Medicaid</strong> Working Group. 441 Stuart Street. 6th Floor. Boston, MA 02116; Phone 617-437-1550.) 6) National Association of Ctildren s Hospitals and Related Institutions: New NACHRI COassificanon Syvtem To Be Released for Children %fts Congenittal and ftronic Health Conditdons. Alexandria. VA: National Association of Children's Hospitals and Related Institutions. 1996. (Request ftomnNACHRI. 401 Wythe Street. Alexandria. VA 22314. Phone 703-684-1355.) 7) Neff JM. Anderson GF: Caring for the uninsured and underinsraed: Protecting children with chronic illness in a competitive marketplace. Journal of the Anfencan Medical Associanton. 274:1866-1869. 1995. 8) Smith NS. Weiner J: Applying population-based case mix adjustment in managed care: The Hopkins Ambulatory <strong>Care</strong> Group system. <strong>Managed</strong> <strong>Care</strong> Quarterlv. 2:21-34. 1994. 9) Weiner JP. Dobson A. Maxwell SL. Coleman K. Starfield BH. Anderson GF: Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health <strong>Care</strong> Financing Review. 17:77-99. 1996. 10) Weiner JP. Starfield BH. Ueberman RN: John Hopkins Ambulatory <strong>Care</strong> Groups (ACGs): A case-mix system for utilization review. quality assurance and capitation adjustment. HMO Practice. 6:13-19. 1991. 11) Weiner J. Starfield B. Steinwachs D. Mumford L: Development and application of.a population-oriented measure of ambulatory care case-mix. Medical <strong>Care</strong>. 29:452-461. 1991. 37
687 MANAGED CARE EXPERT WORK GROUP ON QUALITY OF CARE I) Brook RH. Kamberg CJ..McGlynn EA: Health system reform and quality. Journal ofthe Anmercan Medical Association. 276:476.480. 1996. 2) Center for Quality of <strong>Care</strong> Research and Evaluation: Conquest 1.0: A COtnputenrzd Needs-oriented QUality enrasurement Evahwation SysTem. Boston. MA: Harvard School of Public Health. 1996. (Request from Cemer for Quality of <strong>Care</strong> Research and Education. Harvard School of Public Health. Boston. MA 02115; Phone 617-432-3270.) 3) The Child and Adolescent Health Policy Center: MCN Policy Btief. Quahiry. Qualitv Assessnent, and Qualioy Assurance Considerafionsfor Maternal and hild Health Populations and Practitoners. Baltimore. MD: The Johns Hopkins University. 1995. (Request from The Child and Adolescent Health Policy Center. The Johns Hopkins University. 624 North Broadway. Baltimore, MD 21205: Phone 410-550-5443.) 4) Gold M. Felt S: Reconciling practice and theory: challenges in monitoring <strong>Medicaid</strong> managed care quality. Health <strong>Care</strong> Financing Review. 16:85-105, 1995. 5) Health <strong>Care</strong> Financing Administration: A Health <strong>Care</strong> Quality Improvetnent Svsret for <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong>. Baltimore. MD: HCFA. 1993. 6) Ireys HT, Graton HA, Guyer B: Assuring quality of care for children with special needs in managed care organizations: roles for pediatricians. Pediatrics. 98:178-185. 1996. 7) Maternal and Child Health Bureau: A PrelinsnarY Strategy for Assesuing Cnssunit Syvstems of <strong>Care</strong>for Women, Otildren and Adolescents. Rockville. MD: MCHB, 1995. 8) McGlynn EA: Choosing chronic disease measures for HEDIS: conceptual framework and review of seven clinical areas. <strong>Managed</strong> <strong>Care</strong> Quarrer4s. 4:54-77, 1996. 9) McGlynn EA. Halfon N. Liebowiuz A: Assessing quality of care for children: prospects under health reform. Arclives of Pediatric and Adolescent Medicine. 149: 359-368, 1995. 10) Monahan C, Harder-Shanahan R. Maloney M. Song J: Qualirv Conbmunitv <strong>Managed</strong> <strong>Care</strong>: A Guide for Quality Assurance Measuresfor Qiildren Mt& <strong>Special</strong> Health <strong>Care</strong> Needs. Chicago. IL: The University of Illinois at Chicago. 1996 (draft). (Request from The University of Illinois at Chicago -Division of <strong>Special</strong>ized <strong>Care</strong> for Children, 1919 W. Taylor Street, 8th Floor. Chicago. IL 60612: Phone 312-996-1360.) 11) National Academy for State Health Policy: In QARI: Quality Assurance Reform Initiative Experience in <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong>. Portland. ME: NASHP. 1994. (Request from the National Academy for State Health Policy, 50 Monument Square. Suite 502. Portland. ME 04101; Phone 207-874-6524.) 12) National Association of Children's Hospitals and Related Institutions. Pediatrmc Excellence in Health Deliverv Systemv. Alexandria. VA: NACHRI. 1996. (Request from NACHRI. 401 Wythe Street. Alexandria, VA 22314; Phone 703-684.1355.) 13) National <strong>Committee</strong> for Quality Assurance: <strong>Medicaid</strong> HEDIS. Washington. DC: NCQA. 1996. (Request from NCQA. 2000 L Street. NW. Suite 500. Washington. DC 20036; Phone 202-955-3500.) 14) New England SERVE: Enhancing Quality: Standards and Indicators of Qualy <strong>Care</strong> r Caldren with Specdal Health <strong>Care</strong> Needs. Boston. MA: New England SERVE. 1989. (Request from New England Serve. 9yIl'remont Street. Boston. MA 02108; Phone 617-574-9493.) 15) Newacheck PW. Stein REK. Walker DK. Gortnaker SL. Kuhlthau K. Perrin JM: Monitoring and evaluating managed care for children with chronic illness and disabilities. Pediatrics. 98(5), 1996. 16) Plaut TF. Howell T. Walsh S. Paster M. Jones T: A systems approach to asthma care. <strong>Managed</strong> <strong>Care</strong> Quarrerly 4:6.18, 1996. 38
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S. HRG. 105-262 MEDICAID MANAGED CA
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CONTENTS PEOPLE WITH SPECIAL NEEDS,
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V Bazelon Center for Mental Health
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2 also apparent that structuring a
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4 through the doors when somebody o
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6 delay the onset of secondary disa
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8 BRIEFING FOR CONGRESSIONAL STAFF
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10 obstetric and gynecological serv
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JlSAes CRi. E CalD5Vilb J~iiiLi uls
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14 people with disabilities and spe
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16 and prospective enrollees the pl
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18 by the disorder. In fact, schizo
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20 r_ 06/23/1997 16: 03 7836845968
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22 Kathy. STATEMENT OF KATHLEEN H.
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24 even lead to an improvement-but
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26 MANAGED CARE AND LONG TERM T h e
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Consortium for C. 20249&Oid Citizen
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30 11 Managed care
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Strong Oualitv Assurance Measures 3
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NATIONAL ASSOCIATION 34 DEVELOPMENT
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36 Mrs. M.'s care plan is quite com
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38 nurses and social workers be ava
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40 EXPENDITURES FOR NURSING HOMES S
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REQUIRES THE SKILL OF A HIGHLY TRAI
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44 ALZHEIMER'S DISEASE AND RELATED
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46 WITHOUT ADEQUATE RESPITE CARE, I
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48 PROBLEM FOR PEOPLE SUFFERING FRO
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50 Ms. CHRISTENSEN. Thank you. Don.
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52 it will eradicate the virus. Man
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I 54 Today I participate in a state
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56 Ms. CHRISTENSEN. Thank you. [Ina
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58 rather than to community-based s
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60 now has to start looking at thin
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62 plan for that matter, can measur
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64 ual is getting state-of-the-art
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66 a larger population of people wi
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68 of recovery or rehabilitation th
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70 are entitled to renew their pres
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72 point and say that Patsy comes f
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74 .The WASHNTND MEDICAL CENTER CEN
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76 exceptions - have largely based
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78 Plans have not shown a willingne
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eligible people and for the program
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Table l.b Selected Provisions Relat
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VariiaIioils in rownlr-c1t language
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Variations in cbonIlrlcl Is1sgu;age
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Executive Summary 1. Setting the Co
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age, which pays for those M
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This consensus building exercise is
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95 Ms. CHRISTENSEN. I'm going to in
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97 abled population will all need s
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5601 Smetua- Drive PO. r,. 9310 Mmn
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101 Our experience with the AFDC po
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103 I have tried to list both the o
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105 BACKGROUND INFORMATION PATRICIA
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164 Communicating the Quality Messa
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119 Dr. SCANLON. In this series of
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121 lation in managed care in Minne
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123 thing, because you will have va
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125 If we develop them now around e
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127 I think those are the things yo
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130 to use, and they will be collec
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134 unlikely though that these futu
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136 While we are in the midst of th
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138 Center for Health Program Devel
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140 ('enter for Hearlth Proeram Dev
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146 If More is Better, Cost Contain
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148 ANALYSIS OF OUTCOMES SF-36 phys
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150 4-Year Physical Health Outcomes
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152 MAJOR FINDINGS -1 PHYSICAL DECL
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154 INTERPRETATION OF RESULTS * Equ
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156 Additional Information is on th
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order) were followed. Samplingpatie
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AP Ag. 0065(0 og. qP e8 y. d-ftd 04
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162 Tlbb. 5-Plso91 A& MerohJ H89t0
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and chest pain sufficient to requir
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166 Quality Special</strong
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THE STATE OF THE STATES TUESDAY, JU
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171 a little bit about some of the
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173 gatekeeper, and we also wondere
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175 Maryland ought to submit that w
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177 fined by us in our regulations,
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179 To get to that kind of situatio
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181 Outline of Presentation for Dep
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183 B. Approaches to Ensure Quality
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185 * Holds MCOs accountable for qu
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187 HealthChoice and People with <s
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189 HealthChoice and People with <s
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191 Take these three steps to choos
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193 Call 1-800-888-1965 if you are
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IF YOU HAVE HIV/AIDS 195 MCO staff
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197 * Refer you to a medical specia
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*pV 199 SERVICES FOR CHILDREN IN ST
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201 Ms. CHRISTENSEN. Thank you. Go
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203 We implement these QI goals thr
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205 Medicaid recip
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207 My name is Peggy Bartels. I am
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209 At the forefront of Wisconsin's
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211 Finally, we believe that high q
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213 WISCONSIN DEPARTMENT OF HEALTH
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2 SELECTED INDICATORS Access to <st
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Mental Health 217 * HMOs reported f
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'Nisconsin Medicaid</strong
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Program for Program Chareolorletice
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Primary Program AFDC/H8 Provlqar Ch
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225 Children Come First of Dane Cou
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227 Wraparound Milwaukee saving dol
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229 Another positive outcome of the
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231 AltDoughl Nkvie' iniCil costs i
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233 CCE's staff consist of a variet
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235 Al the cturent time, there is n
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237 PACE/Partnership programs guide
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239 necessarily relevant to the AFD
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241 about including these specialty
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EXECUTIVE COMMITTEE Ct-u B.1r- M.mb
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Considerations: 245 Enrolling <stro
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247 Medicaid <stro
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a. some counties 249 b. mandatory e
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251 counties as well-of managed car
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253 In other States devolution is m
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255 /-LCenter for Health Ca
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257 Forums on Managed</stro
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259 Medicaid Carve
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261 So I view Medicaid</str
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264 Medicaid: Spen
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266 a 50 percent match. 2 Since 198
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268 If enrollment of eligible indiv
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270 drugs, ICF services, and optome
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272 Table 20-1. Medicaid</s
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274 The slowdown in spending after
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276 Section 1115 Demonstration Waiv
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278 primary care case management ar
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280 Table 20-2. Enrollment in <stro
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282 / Figure 20-6. Enrollment Growt
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284 Marnaged-care growth at the sta
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286 Figure 20-9. Enrollment in Risk
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288 The extent of problems in repor
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290 plans (PPRC 1996). In other are
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292 There appears to be a clear tre
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Enrollment and Disenrollment Polici
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296 individually with plans over ra
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298 Health Care Fi
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Medicaid M
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Support & Services Office 120 W. Tw
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INTRODUCTION 304 Presently, nearly
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306 more mandatory services. Full-r
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308 the ability of beneficiaries to
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310 managed care also requires the
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312 condition period. Such requirem
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314 If a state contracts with or in
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Appendix A State Activity* 316 Many
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GA { I ~United States (3 Mu General
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Results in Brief E.. - 320
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Significant Efforts Needed to Ensur
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Recommendations Agency Comments E-d
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cow 326 Chapter 4 Traditional Rate-
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Chapter I Background 328 Me
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ovapt I 330 the option of extending
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Federal Requirements Govern State U
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Table 1.2: Comparison of Ma
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Objectives, Scope, and Methodology
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338 Chapter 2 States Are Moving Tow
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Table 21 nEnollmen of Disabled Bene
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342 chona Se. As To~ed Id C"fn, Dai
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Table a& Eabent to Which 17 State I
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346 So A- hbydf TSo -d Cam fo DIbbi
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Table 2.5: Extent to Which 17 State
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350 8t" Age Bowi T-Mar 11 Cue fRa D
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352 C".Pt a Q...itA- Efl~t. . - C f
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Addressing Concerns Through Enrollm
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Assignment Active Management of a D
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358 fo.V D Axd B ref .Ak,.d - CC-e
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Targeted Quality-of-Care</s
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Encounter Data Analysis Shows Poten
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364 Chapter 4 Risk-Adjusted Rates a
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366 Cu.pd 4 Rk-A4tAjLd Row Ad RIASW
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States Could Experience Adverse Sel
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370 Ckspt. 4 JUek-Mtod Rate Wd HIa
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372 Ch.piWr 4 JU-i.k.d Row md RJAk-
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374 Coob,, 4 RkikAdjned Rtr -d Rub-
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376 rued R.I. . 2".shBd c- provider
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378 c-5 Obh- .. I, Co.eWda, ad CHe
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380 Ob-e-eU-o, Co-ded, end C-ost pr
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382 United States General Accountin
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Results in Brief B-Z70335 384 manag
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B-2Kn0 386 assess service utilizati
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Table 1: Characteristics of <strong
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B-27035 390 numbers of patients. In
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B-270335 392 number of primary care
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B-Z7Oa33 394 developed on the premi
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States Challenged to Develop Effect
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B-270335 398 that beneficiary use o
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B.270335 400 of the care provided a
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States Could Learn More From Improv
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Targeted Analyses of Grievance Data
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Observations Agency Comments and Ou
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B-270335 408 Finally, the experts w
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410 Appendix I Scope and Methodolog
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- I 412 App-edU I Sw Wd Methodology
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414 AppeAdt U Fedo.I aod Stt. Ove0s
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416 Appendix III Major Contributors
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GAO July 1996 GAO/HEHS-96-120 418 U
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B-26632 420 family home, rather tha
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Background 1-206320 422 traditional
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States Use Waivers to Expand and Ch
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84=20 426 Figure 1: Staftes Use of
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B-266320 428 began the 1990s with s
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B26320 430 variety of other service
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Enrollment Caps and Management Prac
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Change in Federal Rule Could Result
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States Are Introducing Innovations
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B-nato 438 offered and the means fo
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440 We are sending copies of this r
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C-m 442 Table 2: Changes in Number
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444 App-ar I So-p and Mraodsogo ent
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446 Appendix H Medicaid</st
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448 App-di. f M~I Wd., _. So 4 Of0
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450 App-.i. il _-.1 - Desd s UCFVA'
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452 Apeadls mn Stadad Seee - Defind
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454 Appedi. M St.d.ed Se&ee s Dneoe
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Chore 456 Am..& IV LAO n.Gd .Mt. ,
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Occupational Therapy and Assessment
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Psychological Services Provider Typ
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462 AWppdi IV U-e, Cotfi-, E d Othe
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Licensure/Registration Other Standa
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466 United States General Accountin
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Results in Brief B-276078 468 care
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B-270078 470 Medi-Cal was implement
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_.27_7 Tab 1: Mad-C Eiglbli and Enr
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~~- - o~~BZ760?S 474 I J I the enro
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B.276078 476 delaying the contracti
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State's Education Process Has Not R
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B.276078 480 and thereby supplement
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Weaknesses in State Management of t
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B-276078 484 standards can provide
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Insufficient Communication and Invo
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Some Safety-Net Providers Are Encou
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Conclusions B-276D78 490 Safety-net
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B-270078 492 current enrollment bro
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Contents Letter 494 Appendix 30 Sco
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(1115) oPP. -.M.taoy 496 oversight
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498 ACKNOWLEDGEMENTS This Volume of
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500 Is Lock-in to a Managed
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502 Plan and Provider Issues ......
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504 Chapter 1 Program Design Issues
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506 Other studies attest to improve
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508 Will the Program Be Voluntary o
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510 additional option for people wi
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512 contractor collect spenddown pa
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514 Option A is still quite rare. P
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516 experience with special populat
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518 particularly on a full risk bas
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520 Dual eligibility raises a disti
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522 special populations, and states
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524 Chapter 2 Care
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526 settings. Finally, plans that s
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5281 needs. For example, women who
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530 Oregon's rules require that pla
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532 beneficiaries on July 1, 1997.
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534 facility's delivery, dosage, an
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536 * Strategies for measuring netw
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538. arrangements with traditional
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540 community based or well elders.
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542 Finally, coordination for vulne
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544 Care Coordinat
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546 home health agency developed a
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548 develop a case management syste
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550 Coordinating services is compli
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Highlights 552 Effective care coord
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554 beneficiaries that belong to th
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556 services when needed. This is t
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558 federal government and not at s
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560 cannot enroll a person in a Med
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562 Medicare members are not typica
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564 Regence HMO Oregon staff noted
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566 community based organizations t
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568 Although technical advice for c
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570 Risk pools are usually used to
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572 Internal Quality Program Standa
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574 enrollee utilization patterns,
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576 that the overall prevalence of
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578 HMOs with risk contracts must h
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580 Summary As Medicaid</st
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582 Chapter 3 Medicaid</str
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584 carve-out approach: - improves
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586 Coordinating Medical and Non-Me
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588 Oregon,8 program planners origi
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590 Medicaid syste
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592 Oversight/Monitoring Quality De
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594 with family and friends, contac
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596 * The type(s) of data necessary
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598 * Specificity of desired result
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600 Initiatives under way may prove
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602 a estring the services authoriz
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604 Development of appropriate plan
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606 OFFICE OF INSPECTOR GENERAL The
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Establishing core developmental tea
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610 taken into account considerable
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PURPOSE 612 INTRODUCTION Our purpos
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614 MANAGED CARE PENETRATION The de
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616 CHALLENGES AND RESPONSES Our re
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618 > In building up and maintainin
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620 * For the most part, the agenci
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622 beginning to look for associate
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624 challenge will be to ensure tha
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626 RETOOLING AS AN ISSUE Retooling
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628 finding effective ways of deali
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630 COMMENTS ON THE DRAFT REPORT We
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Defining Managed <
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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
Page 662 and 663: 660 Description This is an integrat
Page 664 and 665: 12. American Academy of Pediatries
Page 666 and 667: 664 knowledge of a child's conditio
Page 668 and 669: 666 though only the NACHRI approach
Page 670 and 671: 668 Sources Ash A, Porell F, Gruenb
Page 672 and 673: C. Recommended Adivities 670 With t
Page 674 and 675: 672 B. Examples of Current Research
Page 676 and 677: 674 The Practice Parameters Project
Page 678 and 679: 076 -Administrative Survey: Enrollm
Page 680 and 681: 678 Description This guide provides
Page 682 and 683: 680 APPENDIX 1: PARTICIPANT LIST MA
Page 684 and 685: 682 MANAGED CARE EXPERT WORK GROUP
Page 686 and 687: 684 APPENDIX H: BIBLIOGRAPHY MANAGE
Page 690 and 691: 688 MAKING MEDICAID MANAGED CARE PR
Page 692 and 693: 690 On Saturday, July 13, 1996 and
Page 694 and 695: INTRODUCTION Medicaid</stro
Page 696 and 697: 694 INTRODUCTION People living with
Page 698 and 699: 696 |CONSENSUS FOR ATO of many of o
Page 700 and 701: - 698 There is a huge need to educa
Page 702 and 703: 700 People fiving with HIV, and the
Page 704 and 705: 702 The HIV epidemic disproportiona
Page 706 and 707: NATIONAL ASSOCIATION OF PEOPLE WITH
Page 708 and 709: 706 People living with HIV must be
Page 710 and 711: 708 CONSENSUS FOR ACTION service Fo
Page 712 and 713: 710 E . | CONSENSUS FORACTION Peopl
Page 714 and 715: 712 CONSENSUS FOR ACTION _ Under Cr
Page 716 and 717: 714 PNDX Aj MedIcaId -A health care
Page 718 and 719: Resources 716 NAPWAserves as the vo
Page 720 and 721: Medicaid Working G
Page 722 and 723: Background 720 FAMILY"7OICES A nati
Page 724 and 725: 722 was included. A telephone numbe
Page 726 and 727: 724 provider to ask questions. fami
Page 728 and 729: 726 * Families were twice as likely
Page 730 and 731: 728 carefully to explain why they a
Page 732 and 733: Table I Family Voices Survey on <st
Page 734 and 735: Table 2 (continued) Family Voices S
Page 736 and 737: Table 4 Family Voices Survey on <st
Page 738 and 739:
736 Table 7 Family Voices Survey on
Page 740 and 741:
738 Table 8 Family Voices Survey on
Page 742 and 743:
740 Table 10 Family Voices Survey o
Page 744 and 745:
al 742 Table II Family Voices Surve
Page 746 and 747:
744 Tn Uvman 1usoUU - Ya..e. PeMh i
Page 748 and 749:
746 Tihe b d. - Yc'.n-e-aPcopb bith
Page 750 and 751:
748 UT1, W L= 1. - Y g o. ith ,Pb M
Page 752 and 753:
750 o As with the rest of the <stro
Page 754 and 755:
752 Mlbe 1 Mediaid Benefici7 ibtas
Page 756 and 757:
754 9: Office of the Assistant Secr
Page 758 and 759:
The research for this paper Was sup
Page 760 and 761:
Definitions of "Medically Necessary
Page 762 and 763:
Who Should Define What Is Necessary
Page 764 and 765:
762 contract. In that situation, th
Page 766 and 767:
764 sannes and for certain conditio
Page 768 and 769:
Defining Elements of a Definition o
Page 770 and 771:
768 (6J identify and evaluate a men
Page 772 and 773:
770 This paper highlights children'
Page 774 and 775:
772 din resulut in inadequate or in
Page 776 and 777:
774 dividual under public-sector ma
Page 778 and 779:
BAZELON CENTER RESOURCES ON MANAGED
Page 780 and 781:
ivn58ffR1eL_ 778 THF VARIAI LITY OF
Page 782 and 783:
_4 What are the essential benefits
Page 784 and 785:
WHAT PUBLIC PURCHASERS CAN DO - Oen
Page 786 and 787:
ASSESSMENT OF STANDARDS - Quality M
Page 788 and 789:
Accessibility, Availability, Referr
Page 790 and 791:
- Credentialing and Recredtentialin
Page 792 and 793:
Standards for Members' Rights and R
Page 794 and 795:
Preventive Behavioral Health Servic
Page 796 and 797:
9b4 etfJovrk9imut July 16, 1997 794
Page 798 and 799:
hel,4Neipaork SEmi July 16, 1997 79
Page 800 and 801:
798 Principles for Accountable <str
Page 802 and 803:
800 The Coalition for Accountable <
Page 804 and 805:
802 Principles for Accountable <str
Page 806 and 807:
Im. Community 804 Health plans shou
Page 808 and 809:
806 4. participating in community p
Page 810 and 811:
808 5. give patients opportunities
Page 812 and 813:
810 aRve New Children With Disabili
Page 814 and 815:
Table of Contents 812 Executive Sum
Page 816 and 817:
814 combination of HealthPartners d
Page 818 and 819:
Introduction 816 F amilies whose ch
Page 820 and 821:
818 Of the 24 families asked, 13 pa
Page 822 and 823:
820 Shriner's Hospital, or claims s
Page 824 and 825:
822 Major Child and Family Concerns
Page 826 and 827:
Services and Funding Sources 824 Nu
Page 828 and 829:
Physician Survey 826 M ost physicia
Page 830 and 831:
828 Discussion and Recommendations
Page 832 and 833:
830 * Claims and billing informatio
Page 834 and 835:
832 El Advocate for a safety net of
Page 836 and 837:
834 :i:PTNG F'AITH SYMThMr -"r W, M
Page 838 and 839:
836 We recognize that managed care
Page 840 and 841:
due to a host of complex demographi
Page 842 and 843:
affect many different facets of an
Page 844 and 845:
state agencies, must be held accoun
Page 846 and 847:
In selecting managed care entities
Page 848 and 849:
Z, W 0 V==4 . k PQ- 0 V-- 9 Q) bo =
Page 850 and 851:
plans were virtually identical in b
Page 852 and 853:
to chronically i persons has been t
Page 854 and 855:
Managed Risk Medic
Page 856 and 857:
the lead. Large purchasers might wo
Page 858:
ISBN 0-16-055952-9 9 [ 10111111 155
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Medicaid Managed Care - U.S. Senate Special Committee on Aging

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