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
Im. Community 804 Health plans should affirmatively and continuously identify and respond to the needs of their communities. While the appropriate definition of community service will vary among plans, it should extend beyond enrollees and include vulnerable and underserved populations within the plan's geographic area. In addition, plans should be culturally competent. Their programs and services should meet the needs of persons from various backgrounds who have different perceptions and reactions to health issues. Plans demonstrate accountability to their communities and commitment to community service by: 1. providing benefits to the community in response to community needs, including: * efforts to promote health and prevent disease and injury among the enrolled population and in the broad community * outreach services provided directly by the plan, by participating providers of the plan, and in collaboration with other public and private service organizations, and * the provision of care to persons unable to pay, underserved portions of the community, and high risk patients, 7
805 2. advocating publicly for community health promotion and disease prevention policies; and 3. publishing information regarding contributions of the plan to the community. IV. Health System Improvement Health care providers and managed care plans benefit from investments in the education of physicians and other health professionals, basic and applied medical research, and innovation in the delivery of health services and public-health. To help ensure the continued growth of medical knowledge and its effective application, managed care plans should directly and indirectly support programs and efforts that contribute to the continued improvement of the health care system as a whole. The contributions expected of a plan include at least: 1. direct funding or participation in funding mechanisms to support medical and other health professional education and research; 2. encouraging medical and health professionals' education and training opportunities at plan-affiliated institutions; 3. participating in studies of health services research, including collecting and analyzing data to develop valid and reliable risk adjustment mechanisms; and 8
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- Page 800 and 801: 798 Principles for Accountable <str
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- Page 814 and 815: Table of Contents 812 Executive Sum
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805<br />
2. advocating publicly for community<br />
health promoti<strong>on</strong> and disease preventi<strong>on</strong><br />
policies; and<br />
3. publishing informati<strong>on</strong> regarding<br />
c<strong>on</strong>tributi<strong>on</strong>s of the plan to the community.<br />
IV. Health System Improvement<br />
Health care providers and managed care<br />
plans benefit from investments in the educati<strong>on</strong><br />
of physicians and other health professi<strong>on</strong>als,<br />
basic and applied medical<br />
research, and innovati<strong>on</strong> in the delivery of<br />
health services and public-health. To help<br />
ensure the c<strong>on</strong>tinued growth of medical<br />
knowledge and its effective applicati<strong>on</strong>,<br />
managed care plans should directly and<br />
indirectly support programs and efforts<br />
that c<strong>on</strong>tribute to the c<strong>on</strong>tinued improvement<br />
of the health care system as a whole.<br />
The c<strong>on</strong>tributi<strong>on</strong>s expected of a plan<br />
include at least:<br />
1. direct funding or participati<strong>on</strong> in<br />
funding mechanisms to support medical<br />
and other health professi<strong>on</strong>al educati<strong>on</strong><br />
and research;<br />
2. encouraging medical and health<br />
professi<strong>on</strong>als' educati<strong>on</strong> and training<br />
opportunities at plan-affiliated instituti<strong>on</strong>s;<br />
3. participating in studies of health<br />
services research, including collecting and<br />
analyzing data to develop valid and reliable<br />
risk adjustment mechanisms; and<br />
8