This presentation is about Network Health, the Medicaid Managed Care organization associated with the Cambridge Health Alliance(CHA).
Network Health began in July 1997 as part of the Massachusetts 1115 Waiver. One of the goals it initially accomplished was to channel additional patients into Cambridge Hospital and the rest of the CHA system. Early in 1999, CHA realized that the health plan had to expand its membership by growing into additional geographic areas. One reason was the limited number of Medicaid patients in Cambridge and Somerville. Another was the high turnover rate of Medicaid enrollees.
CHA's traditional role as a provider has diminished while the role of Network Health as a network model HMO has increased. The author will talk about how Network Health can survive and thrive in an environment that has reduced the number of MCOs operating in Massachusetts Medicaid from 12 in 1997 to the current 4. Of these, 3 are Medicaid only and 2 are programs of the safety net systems Cambridge Health Alliance and Boston Medical Center.
The presentation will also discuss some of the major challenges faced while building a health plan that is high quality and attractive to both members and providers while controlling medical costs, has adequate infrastructure to meet the demands of Medicaid while controlling administrative cost, for a target population with great cultural diversity, and within a provider community that often views "managed care" as anathema. Not to mention decreasing premiums.
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 plans are affected by their local environments
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.