This presentation is about MetroPlus Health Plan, the managed care plan that is owned and operated by the New York City Health and Hospitals Corporation (HHC). It will discuss the ways in which a safety net provider owned plan can assist in keeping the safety net in place, focusing on the external forces and politics that impact the ability to do this successfully.
Medicaid managed care plans are operating in an environment where managed care is under a nationwide cloud of negative feelings and where there are a number of other constraints. A strategy is needed for changing this environment to one that provides quality healthcare in a rational, cost effective way and is not piecemeal, anecdotal and reactive.
Also discussed will be ways in which a provider owned plan can identify and assist in the implementation of changes that have to be made in the infrastructure and care delivery systems in order to survive in a managed care environment. Although safety net providers have always had public health as a focus and have been involved in many outreach and education programs, the advent of managed care has meant that they must make a greater transition from managed care to managed health. The impact of this change on the safety net provider and the steps being taken to successfully implement the change with less funds, in an atmosphere that is requiring an ever increasing amount of accountability from both plans and providers will be discussed.
Learning Objectives: 1) Understand the distinctive roles and dilemmas of public managed care plans. 2) Understand how these plans have been used as a tool for protecting the financial viability of public hospitals and other safety net providers. 3) Evaluate their effectiveness in carrying out that role. 4) Compare the organization and strategies of different public managed care plans. 5) Examine how the local environment affects the public managed care plans
Keywords: Managed Care, Public Hospitals
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.