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

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of recovery or rehabilitation that we often expect from other kinds
of conditions.
It is very important as people with chronic conditions move into
managed care that these other goals become identified and accepted
as legitimate goals and that the plans recognize that services
are going to be provided to achieve those kinds of goals. It is a difficult
issue in part because we don't have good research to establish
the relationship between services and these goals, which are somewhat
more subtle than outcomes such as rehabilitation and recovery.
In conclusion let me say that I think the panel 2 weeks ago did
an excellent job in terms of expressing the range of needs of persons
with special needs as well as expressing some concerns about
the capacity and interest of managed care in serving such individuals.
However, management of care is something that such individuals
may actually benefit from. We heard very vividly how complex the
care is that such individuals require, and having a manager to assist
one through the maze of providers seems like an ideal situation.
It is a situation that does not always arise in the fee-for-service
system, and turning to managed care organizations may provide
us an opportunity to increase its prevalence. It seems something
that managed care organizations should be capable of undertaking
and doing well, but we do need to be very concerned that we pay
them appropriately for the tasks and that we hold them accountable
for accomplishing the tasks that we have asked them to do.
That is all. Thank you very much. I would be happy to answer
any questions that you may have later.
MS. CHRISTENSEN. Thank you.
Barbara, before you get started, if anybody wants to come up,
there are some seats up here.
Barbara.
STATEMENT OF BARBARA MARKHAM SMITH, SENIOR RE-
SEARCH STAFF SCIENTIST, CENTER FOR HEALTH POLICY
RESEARCH, THE GEORGE WASHINGTON UNIVERSITY, WASH-
INGTON, DC
Ms. SMITH. I am Barbara Smith, and it is a pleasure to be here
today.
I want to tell you a little bit about the contract study that we
did at the Center for Health Policy Research, because in many
ways, the study that we did is the empirical confirmation of the
guidelines that Bill just set forth.
We took the contracts between the States and the <strong>Medicaid</strong> managed
care companies, and we analyzed the content of those contracts
according to specific parameters and guidelines, looking, for
example, at what the contracts required in terms of network composition
or quality assurance programs or how they handled enrollment.
I want to emphasize that this study looked at the four corners
of the contracts only; what was the infrastructure, what was the
relationship, what were the requirements and specifications set
forth in the contracts. We did not do field visits. We did not do a
qualitative studies on which States had better managed care pro-