The New York City Council created a managed care consumer assistance program to help vulnerable New Yorkers enrolled in managed care plans understand their rights as members and to navigate their health plan to get needed services. The Community Service Society (CSS), an independent, not-for-profit, social service and advocacy organization, was contracted to design and implement the managed care ombudsprogram. To identify priority groups for the program, CSS conducted a citywide, random telephone survey in the 5 major languages spoken in the city (English, Spanish, Haitian-Creole, Chinese, and Russian) to identify subgroups who experience the most difficulty receiving managed care services. Specific target populations were identified through this survey with a sample of over 800 respondents: recent immigrants, non-English speakers, low income populations, and people with chronic or disabling conditions. To serve these populations, CSS is establishing a citywide network of community-based organizations (CBOs) with the expertise to help diverse communities address managed care questions and problems. CSS will also collect data documenting systemic problems that diminish the quality and accessibility of health care services in the City. Up to 20 community-based social service providers will participate in the NYC ombudsprogram, providing fully accessible services in linguistically and culturally appropriate settings.
Learning Objectives: At the conclusion of this session, the participant will be able to: 1) identify the populations most adversely affected by managed care; 2) describe the community-based approach of the New York City ombudsprogram; 3) assess the value of the network approach in providing accessible, and appropriate consumer assistance to vulnerable patients
Keywords: Ombuds Programs, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: The program is operated by the Community Service Society of New York, a not-for-profit social service, social policy and advocacy organization
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.