Search Results: MCHLine

Annotation: The goal of this project was to assist in the formation of a collaborative effort involving the government, providers, private payers, and families in order to reconcile the operational difficulties of achieving health care cost containment while retaining quality, access, and family-centeredness. The project sought to: develop approaches to health care financing that are sensitive to the needs of families with children who have special health care needs; assist families with special health care needs in dealing with financial problems which pose barriers to obtaining appropriate health services; and disseminate information regarding financing of care for children with special health care needs. Family health benefits counselors assisted approximately 1600 over the course of the project by conducting intake interviews, informing families about health care financing options, assisting in completing applications and/or filing appeals or denials of public or private benefits and facilitating negotiations with medical creditors. Consultation with legal backup and referral for legal intervention were distinguishing aspects of the project. Benefits counselors and project attorney worked with state and county administrative and regulatory agencies, private insurers and health care providers and associations to resolve systemic problems. [Funded by the Maternal and Child Health Bureau]

Contact: National Technical Information Service, O.S. Department of Commerce, 5301 Shawnee Road, Alexandria, VA 22312, Telephone: (703) 605-6050 Secondary Telephone: (888) 584-8332 E-mail: [email protected] Web Site: http://www.ntis.gov Document Number: NTIS PB93-199156.

Keywords: Advocacy, Case Management, Chronic illnesses and disabilities, Families, Family health, Financial Counseling, Financing Health Care, Health Insurance, Health Maintenance Organizations (HMOs), Medicaid, Reimbursement

Annotation: This paper describes a study conducted to examine the effects of Medicaid managed care on prenatal care utilization and infant health. Topics include estimating the effect of primary care case management (PCCM) managed care programs and health maintenance organization (HMO) managed care plans on prenatal care utilization, birth weight, and cesarean section. The paper includes sections discussing previous research; the empirical model and statistical methodology used in the study, the data, and results; and a final section reviewing study findings. Statistical information is presented in tables throughout the paper and in the appendix. A reference list is provided.

Contact: National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138-5398, Telephone: (617) 868-3900 Fax: (617) 868-2742 E-mail: [email protected] Web Site: http://www.nber.org Available from the website.

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Keywords: Case management, Cesarean section, Evaluation, Health care delivery, Health care utilization, Health maintenance organizations, Infant health, Low birthweight, Medicaid managed care, Prenatal care, Primary care

Annotation: This report focuses on in-depth case studies of six employers, two health maintenance organizations (HMOs), and one managed behavioral healthcare organization (MBHO) in an effort to provide examples for other companies and managed care organizations to consider when developing their own programs. The report includes an overview and background information, a description of the methodology used in selected the case study sites, and sections on findings from employers and HMOs and the MBHO. Key findings include characteristics of the study participants, the mental health benefits provided, benefit management approaches, employee satisfaction and performance data, examples of best practices, and challenges remaining. Appendices include the advisory panel roster, list of study participants, employer case studies, and managed care organization case studies. References conclude the report.

Contact: U.S. Substance Abuse and Mental Health Services Administration, One Choke Cherry Road, Rockville, MD 20857, Telephone: (877) SAMHSA-7 Secondary Telephone: (877) 726-4727 E-mail: Web Site: https://www.samhsa.gov Available at no charge; also available from the website. Document Number: DHHS SMA 01-3481.

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Keywords: Case studies, Comprehensive health care, Employee assistance programs, Employee benefits, Health maintenance organizations, Managed care, Mental health, Program descriptions

Annotation: This report provides employee benefits managers and purchasers with guidance on how to purchase mental health insurance benefits that promote cost-effectiveness, access to treatment, and high-quality care. Sections include: mental disorders in the workplace: prevalence, impact and treatment; typical benefits packages for mental health treatment; improving mental health insurance benefit design; and mental health benefits packages that incorporate the design recommendations. The appendices provide information on a case study and advisors and consultants to the report. Tables throughout the report illustrate a variety of benefit package features.

Contact: U.S. Substance Abuse and Mental Health Services Administration, One Choke Cherry Road, Rockville, MD 20857, Telephone: (877) SAMHSA-7 Secondary Telephone: (877) 726-4727 E-mail: Web Site: https://www.samhsa.gov Available at no charge; also available from the website. Document Number: DHHS SMA 03-3542.

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Keywords: Access to health care, Cost effectiveness, Costs, Employee benefits, Employer initiatives, Health insurance, Health maintenance organizations, Mental health, Mental health services, Preferred provider organizations, Private sector

Contact: National Governors Association, Center for Best Practices, Hall of the States, 444 North Capitol Street, Suite 267, Washington, DC 20001-1512, Telephone: (202) 624-5300 Contact Phone: (202) 624-5306 Fax: (202) 624-5313 E-mail: [email protected] Contact E-mail: torloffnga.org OR jharrisnga.org Web Site: http://www.nga.org/cms/center Available from the website.

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Keywords: California, Consumers, Florida, Georgia, Health maintenance organizations, Health services delivery, Managed care, Missouri, New Jersey, New York, Program evaluation, Quality assurance, Texas, Vermont, Virginia

Annotation: This report examines core issues purchasers should consider in developing state Medicaid managed care contracts. These issues are outreach, enrollment, and information; sound financial structures; standards and guidelines; quality assurance; collecting and reporting data; monitoring and evaluation; assuring appropriate provider networks and accessible settings; assuring access to needed services through service planning and care coordination; and linking resources. [Funded by the Maternal and Child Health Bureau]

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Keywords: Access to health care, Contract services, Data collection, Enrollment, Evaluation, Guidelines, Health maintenance organizations, Medicaid managed care, Monitoring, Outreach, Provider networks, Quality assurance, Reports, Standards, State health insurance programs

Annotation: This publication summarizes key findings from the American Association of Health Plan's (AAHP) assessment of four health plans that have implemented model programs to address the health issues arising from domestic violence and other forms of violence against women. A brief overview of related literature and the issue in general is included as well as a detailed description of the four programs selected as case studies, a summary of the lessons learned from each effort, and a contact person who can provide more information on each highlighted program.

Contact: America's Health Insurance Plans, 601 Pennsylvania Avenue, N.W., South Building, Suite 500, Washington, DC 20004, Telephone: (202) 778-3200 Contact Phone: (202) 778-8471 Fax: (202) 331-7487 E-mail: [email protected] Web Site: http://www.aahp.org

Keywords: Case studies, Domestic violence, Health maintenance organizations, Literature reviews, Violence, Women

Annotation: This issue brief summarizes observations and lessons learned from a National Governors' Association Center for Best Practices conference on managed care quality held in Washington, DC, on December 4-5, 1997. Four issues are addressed: providing consumer protections, enhancing the quality of care, coordinating state regulatory administrative structures, and developing performance measurement systems. Key conclusions from the conference are outlined. Discussion of efforts in Missouri, New Jersey, Ohio, Texas and Vermont to protect health care consumers and enhance the quality of health services is also included. The work of the National Committee for Quality Assurance and the Foundation for Accountability is also described.

Contact: National Governors Association, Center for Best Practices, Hall of the States, 444 North Capitol Street, Suite 267, Washington, DC 20001-1512, Telephone: (202) 624-5300 Contact Phone: (202) 624-5306 Fax: (202) 624-5313 E-mail: [email protected] Contact E-mail: torloffnga.org OR jharrisnga.org Web Site: http://www.nga.org/cms/center Available from the website.

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Keywords: Conferences, Consumer protection, Consumers, Health maintenance organizations, Health services delivery, Managed care, Missouri, New Jersey, Ohio, Program evaluation, Quality assurance, Texas, Vermont

Annotation: This report presents lessons learned from Healthy Start grantees as they planned and implemented the Healthy Start Initiative, a five-year demonstration program that uses a community-driven, systems development approach to reduce infant mortality and improve the health and well-being of women, infants, children, and families. This volume discusses the basics of health maintenance organizations, state Medicaid managed care programs, and how Healthy Start programs can work with both programs. It gives information on preparing to act as a contractor, deciding what services to offer, developing and marketing a managed care proposal, and proposing and negotiating a contract. [Funded by the Maternal and Child Health Bureau]

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Keywords: Contract services, Health maintenance organizations, Health promotion, Healthy Start, Infant health services, Infant mortality, Maternal health services, Medicaid managed care, Outreach, Perinatal care

Annotation: This manual looks at the current health financing and child welfare systems that provide health care to children in foster care and suggests alternatives within a fee for service structure and within a risk-based capitated structure. An appendix summarizes the alternatives in a table and provides definitions of managed care organizations.

Contact: National Academy for State Health Policy, 10 Free Street, Second Floor, Portland, ME 04101, Telephone: (207) 874-6524 Secondary Telephone: (202) 903-0101 Fax: (207) 874-6527 E-mail: [email protected] Web Site: http://www.nashp.org Price unknown.

Keywords: Capitation, Child welfare, Children with special health care needs, EPSDT, Foster care, Foster children, Health maintenance organizations, Managed care, Models, Primary case care management, Service delivery, Service delivery systems

Annotation: This paper examines report cards that hospitals, nursing homes, and health maintenance organizations should have. Six criteria for evaluation are listed: validity, comprehensiveness, comprehensibility, relevance, reasonableness, and functionality. The guide discusses why many health care report cards produced by public and private organizations fail to meet these criteria although this varies across states and health sectors. The quantity and quality of state government and magazine report cards for all three types of health care providers are assessed. The information systems that have been created in each of the three domains is characterized. An extensive reference list is included.

Contact: Georgetown University, McCourt School of Public Policy, Old North, Suite 100, Washington, DC 20057, Telephone: (202) 687-5932 Contact Phone: (202) 687-6817 Fax: (202) 687-5544 E-mail: [email protected] Web Site: http://mspp.georgetown.edu/ Price unknown.

• Published Paper July 1998

Keywords: Assessment, Consumers, Health maintenance organizations, Hospitals, Nursing homes

Annotation: This issue brief discusses legislation on Medicaid managed care that has at least passed one house of state legislatures. The summaries provided are not meant to be comprehensive, but to highlight certain issues and to give an overview of the trends that are emerging so far this year in terms of Medicaid managed care. Summaries are provided regarding creating or expanding Medicaid managed care programs, Medicaid managed care, caution on managed care for the elderly and persons with disabilities, oversight of managed care organizations and setting criteria for health maintenance organizations, protections for Medicaid managed care recipients, ensuring quality of care, Medicaid managed care fraud, and pharmaceuticals. Summaries are provided for legislation in California, Colorado, Connecticut, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, and Washington. This information is current through September 25, 1997.

Keywords: California, Colorado, Connecticut, Disabilities, Disabilities, Florida, Fraud, Hawaii, Health maintenance organizations, Illinois, Indiana, Kansas, Louisiana, Managed care, Maryland, Medicaid managed care, Michigan, Minnesota, Mississippi, Nevada, New Jersey, New Mexico, New York, North Dakota, Oklahoma, Older adults, Oregon, Pennsylvania, Pharmaceuticals, Quality assurance, Rhode Island, Special health care needs, State legislation, Tennessee, Texas, Virginia, Washington

Annotation: This statistical summary provides a broad range of data from many sources on health care systems and on those who use them, pay for them, provide services within them, or make policy relating to them. The introduction describes the organization, the purpose, and the use of the book; detailed data are provided for states and metropolitan statistical areas for a broad array of subjects. Sample topics on those using health systems include: population, race, age, family characteristics, personal income, birth rates, perinatal care, fetal mortality, low birthweight babies, vaccination, unemployment, and other health conditions. Selected topics on paying for health services are: insurance status and source; health maintenance organization data on enrollment, penetration, number of plans, competition, and participation by household. Some of the topics on providing health services are: hospital capacity, utilization, and expenses; number of beds; physician, nursing, and physician service expenditures; and expenditures for dental, home health, drug and medical nondurables, vision, and nursing home care and other institutional services. Examples of state data on the development of policy affecting health services include: insurance reform, coverage for targeted populations, Medicaid waivers, managed care related statutes, and cost containment efforts.

Keywords: Demographics, Health care systems, Health insurance, Health insuring organizations, Health maintenance organizations, Health services, Health statistics, Medicaid, Medicare, Sociocultural factors, Socioeconomic factors, State data, Statistics

Annotation: This report summarizes current information on environmental, behavioral, and biological health risks among children and adolescents and offers 15 practical approaches for enhancing preventive and primary care in managed care arrangements, with examples from health maintenance organizations. The approaches cover the following topics: new member and community needs assessments; alternative settings, outreach, telephone advice, prompt appointments, and integration of primary and preventive care; screening, multidisciplinary teams, health education, and case management; and primary care features such as specially trained providers, mental health services, flexible gatekeeping, intensive follow-up, and coordination with public health, education, and social services. [Funded by the Maternal and Child Health Bureau]

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Keywords: Adolescent health, Child health, Health maintenance organizations, Managed care, Prevention, Primary care, Program descriptions

Annotation: This annual compilation of health insurance data focuses on managed care programs, medical care costs, hospital utilization, and morbidity and mortality statistics. The sources for this book are the Health Insurance Association of America's annual survey along with reports from insurance companies, government agencies, hospital and medical associations, and private research companies. Tables depict interrelationships between medical costs and the Consumer Price Index, physician fees, and the Gross National Product. The report includes figures on the Social Security Disability Insurance Program, workplace injuries, childbirth costs, transplant procedures, and AIDS-related expenditures. Hospital utilization statistics such as discharge rates, length of stay, and uncompensated care expenditures include data for community hospitals. A historical overview of the health insurance industry and health maintenance organizations is included along with a chronological listing of industry-related facts.

Keywords: AIDS, Age factors, Costs, Employers, Gender, Health care financing, Health insurance, Health maintenance organizations, History, Hospitals, Injuries, Managed care, Marital status, Medicaid, Medicare, Mental disorders, Mortality, Race, Services, Socioeconomic factors, Statistics, Substance abuse, Surveys, Trends, Uninsured persons

Annotation: This report considers the assumptions that analysts use to make cost projections for the various proposals that are being considered for reforming the national health care system. It reviews the potential effects of four common provisions that affect the possible reforms: cost containment, managed competition and increasing enrollments in health maintenance organizations, uninsured persons, and administrative changes. The report reviews the analyses that have been made of the proposed reforms to determine how key policies were estimated, and it considers factors that may contribute to the degree of uncertainty that affects the reliability of the estimates. The report includes summaries and indicates possible policy implications.

Contact: U.S. Government Publishing Office, 732 North Capitol Street, N.W., Washington, DC 20401, Telephone: (202) 512-1800 Secondary Telephone: (866) 512-1800 Fax: (202) 512-2104 E-mail: [email protected] Web Site: http://www.gpo.gov Available from the website. Document Number: GPO 052-003-01374-6; ISBN 0-16-045062-4; OTA-H-594.

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Keywords: Administrative policy, Cost containment, Enrollment, Health care costs, Health maintenance organizations, Managed competition, National health care reform, Policy development, Service delivery, Uninsured persons

Annotation: This paper examines legislative initiatives relating to managed care in the states during 1994. The paper contains three sections: the first is an essay which analyzes the overall trends for the year, the second is a table summarizing the legislative activities by state and subject area, and the third contains the texts of the laws organized alphabetically by state. The major trends centered on any willing provider clauses, Medicaid managed care, and comprehensive utilization reviews; other legislative initiatives included providing consumer protection, and legislation relating to Section 1115 waivers.

Contact: George Washington University, Intergovernmental Health Policy Project, National Conference of State Legislators, 444 N. Capitol Street, N.W., Suite 515, Washington, DC 20001, Telephone: (202) 624-5400 Fax: (202) 737-1069 E-mail: [email protected] $35.00 plus $5.00 shipping and handling.

Keywords: Consumers, Health maintenance organizations, Managed care, Medicaid managed care, Preferred provider organizations, Provider participation, Regulations, State health care reform, State legislation, Utilization review, Waiver 1115

Annotation: These conference program materials for the National Conference on Managed Care Systems for Mothers and Young Children held in April, 1992 include a program guide, Model Program Workshops Background Materials, and a list of participants. Issues and topics raised at the conference included caring for children, quality assurance of health care, caring for pregnant women, the future of Medicaid managed care, the consumer perspective in health care, ongoing outreach, and linkages among programs serving low-income populations. The background materials provide information on 14 model programs selected by the co-sponsors as examples of health care programs which may improve the health status of pregnant women and children; these model programs were the subject of workshops held at the conference.

Contact: National Academy for State Health Policy, 10 Free Street, Second Floor, Portland, ME 04101, Telephone: (207) 874-6524 Secondary Telephone: (202) 903-0101 Fax: (207) 874-6527 E-mail: [email protected] Contact E-mail: 73512.316.compuserve.com Web Site: http://www.nashp.org Available from the website.

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Keywords: Child health promotion, Conferences, Consumer education, Health care financing, Health maintenance organizations, Insurance, MCH programs, MCH services, Managed care, Model programs, Socioeconomic factors

Annotation: This report evaluates the HealthPASS (Philadelphia Accessible Services System) program, a managed care system for some 115,000 Medicaid recipients in south and west Philadelphia. HealthPASS uses a health maintenance organization (HMO) model to provide care. The report describes the program's financing, structure, and activities, and evaluates whether members are receiving timely and appropriate pregnancy-related services; Early and Periodic Screening, Diagnostic and Treatment (EPSDT); and services through the Special Supplemental Food Program for Women, Infants and Children (WIC). The report also examines whether the financial incentives offered to participating physicians compromise the quality of care provided, and evaluates the program's quality assurance system and credentialing process.

Contact: U.S. Government Accountability Office, 441 G Street, N.W., Washington, DC 20548, Telephone: (202) 512-3000 Secondary Telephone: E-mail: [email protected] Web Site: http://www.gao.gov Available from the website. Document Number: GAO/HRD-93-67.

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Keywords: Capitation rates, Health maintenance organizations, Medicaid managed care, Pennsylvania, Program evaluation, Quality assurance

Annotation: This practical guide for parents and others responsible for the health care of children with special health needs includes information on health insurance issues, health maintenance organizations and mandated care plans, Medical Assistance, and Supplemental Security Income (SSI). The book also describes several forms of assistance available to Wisconsin families such as the Health Insurance Risk Sharing Plan (HIRSP), the variety of state and county programs specifically designed for children with special health needs, home care services, laws aimed at improper debt collection, health benefits counseling, advocacy, and legal assistance. This book supersedes "Health Care Coverage for the Child with a Chronic Illness or Disability." [Funded by the Maternal and Child Health Bureau]

Keywords: Children with special health care needs, Eligibility determination, Health care financing, Health insurance, Health maintenance organizations, Insurance, Medicaid, Supplemental Security Income, Wisconsin