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
Table of Contents 812 Executive Summary ................................... 4 Introduction...................................................... 7 Objectives end Methods .................................. 8 Parent Advisory Council ........... ........................... 8 Parent Survey ...................................... 9 Participants in Parent Survey By Condition & Age ..................... 9 Utilization and Cost Data ............ ......................... 10 Physician Survey ..................................... 11 Community Advisory Council .................. ................... 11 Family Perceptions and Needs ..................... 12 Results from the Parent Advisory Council .................................. 12 Results from the Family Survey ..................... ................ 12 Major Child and Family Concerns .............................. ....... 13 Financing........................................................................................... 14 Services and Funding Sources ................... ................... 15 Cost and Utilization Analysis ......................... 16 Physician Survey ................................... 17 Community Advisory Council ............... ........ 18 Discussion. & Recommendations .................. 19 What can HealthPartners do? ................ ..................... 20 What can communities do? .............. ....................... 22 Conclusion........................................................................................ 23 Collaborators ........... . 24 Children with Disabilities, Families had
Executive Summary The political conflict is clear: If HealthPartners provides a more generous or comprehensive benefit package than its competitors, it will cost more and drive out the healthier population to whom the expanded benefit package is unimportant. Page 4 813 H ealthPartners, the Center for ;Children with Chronic Illness and Disability at the University of Minnesota, _________and PACER Center completed a nine month planning grant from The Robert Wood Johnson Foundation to understand the range of needs and costs for the pediatric population with chronic illness and disabilities in a managed care environment. They completed: * An in-depth interview with 35 parents of children with chronic conditions. * A financial analysis of 410 children within eight categories of chronic conditions. * A survey of HealthPartners physicians to understand their perspective of providing services to young people with disabilities and chronic illnesses. In addition, they convened two community working groups-a Parent Advisory Council and a Community Advisory Council. The data indicate that most families are satisfied with their child's pediatrician and overall health care. The families, the physicians and the community members participating in this study value relationships with each other. All agree that when physicians, teachers, social workers and the family communicate, the child benefits. While families appreciate the convenience of having a primary care clinic at the site where most medical care occurs, they report their pediatrician often does not have the time and knowledge to act as coordinator for the child's non-medical needs. Case management is often mentioned as a desired service by families, physicians, and the Community Advisory Council. While families indicate that their pediatrician is doing a good job coordinating medical care, they also indicate pediatricians are relatively uninvolved with other issues. Case management should represent and advocate for the needs of the child and family in the areas of education, social and community services, in addition to health care. HealthPartners does not cover all expenses incurred by the family. The costs are currently being underwritten by a 3 wAVe New >RA1P.A4ewsf;
- Page 764 and 765: 762 contract. In that situation, th
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- Page 772 and 773: 770 This paper highlights children'
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- 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
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- 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
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- Page 818 and 819: Introduction 816 F amilies whose ch
- Page 820 and 821: 818 Of the 24 families asked, 13 pa
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- 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
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- Page 844 and 845: state agencies, must be held accoun
- Page 846 and 847: In selecting managed care entities
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- 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
Table of C<strong>on</strong>tents<br />
812<br />
Executive Summary ................................... 4<br />
Introducti<strong>on</strong>...................................................... 7<br />
Objectives end Methods .................................. 8<br />
Parent Advisory Council ........... ........................... 8<br />
Parent Survey ...................................... 9<br />
Participants in Parent Survey By C<strong>on</strong>diti<strong>on</strong> & Age ..................... 9<br />
Utilizati<strong>on</strong> and Cost Data ............ ......................... 10<br />
Physician Survey ..................................... 11<br />
Community Advisory Council .................. ................... 11<br />
Family Percepti<strong>on</strong>s and Needs ..................... 12<br />
Results from the Parent Advisory Council .................................. 12<br />
Results from the Family Survey ..................... ................ 12<br />
Major Child and Family C<strong>on</strong>cerns .............................. ....... 13<br />
Financing........................................................................................... 14<br />
Services and Funding Sources ................... ................... 15<br />
Cost and Utilizati<strong>on</strong> Analysis ......................... 16<br />
Physician Survey ................................... 17<br />
Community Advisory Council ............... ........ 18<br />
Discussi<strong>on</strong>. & Recommendati<strong>on</strong>s .................. 19<br />
What can HealthPartners do? ................ ..................... 20<br />
What can communities do? .............. ....................... 22<br />
C<strong>on</strong>clusi<strong>on</strong>........................................................................................ 23<br />
Collaborators ........... . 24<br />
Children with Disabilities, Families had <str<strong>on</strong>g>Managed</str<strong>on</strong>g> <str<strong>on</strong>g>Care</str<strong>on</strong>g><br />
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