With 46 million Americans still uninsured for their health care, the need for creative delivery strategies to reach individuals and their communities is critically important. In all 50 states the agency responsible for financing care for the poor is the state Medicaid agency. AHCs are often in the business of providing care directly to clients, particularly those publicly supported AHCs that have special responsibilities as “safety net providers”.
This Workshop will present one AHC which has established a contractual working relationship with a state Medicaid agency, as a model. Begun in 1996, this $6 million dollar program provides technical assistance, support and policy recommendations for the state Medicaid agency, working closely with the insurer and its physician providers on policy and new program development in six areas:
1)Managed Care Readiness in Community Health Centers 2)Education & Training of Health Care Providers in the Community 3)Developing Cultural Competency within the Provider Work Force 4)Dental Service Capacity-Building and Outreach 5)Work Force Development 6)Health Care Access and Medical Services Outreach
The workshop will include discussion of the history and evolution of the program; discussion about Medicaid and important technical issues pertaining to how it contracts with MCOs and individual providers; and discussion of the financial implications of the program. Further, a rationale for why an AHC should be interested in such an insurance alliance will be presented and debated, since the alliance may suggest a challenge to the traditional missions of the AHC, i.e., promoting provider cultural competency, provider education in disease management, etc.
Learning Objectives: The overriding goal of this presentation is to share with the learner practical aspects of a developing academic health center / managed care organization (AHC/MCO) partnership utilizing the unique expertise of each agency focusing on an underserved target population. (Academic Health Centers generally consist of an allopathic or osteopathic school of medicine, at least one other health professions school or program, and one or more teaching hospitals; definition of the Association of Academic Health Centers). The MCO referenced in this workshop will be an Independent Practice Association sponsored by the state Medicaid authority. The objectives include: 1) Introduce audience to a type of MCO which exists in each state (Medicaid Program); 2) Describe reasons why a public AHC has interest in a relationship with a public MCO; 3) Describe the elements which constitute a workable interagency agreement; and 4) Focus on those elements of the relationship, which relate to the specific needs of the target recipient population, e.g. promoting cultural competency in the work force, education and training of workforce on other issues such as disease management and use of interpreters, etc. It is hoped at the close of the session, participants will have an understanding of a unique University-State Agency-Managed Care Partnership and consider its potential for implementation in their own states and communities
Keywords: Partnerships, Access to Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
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.