California has moved 2 million Medi-Cal beneficiaries into managed care. Health Net, an IPA model HMO, under contract to the California Department of Health Services, is a major participant in this new system of care in seven counties, the largest being Los Angeles. Challenges associated with the interaction of public health programs and managed care plans have led to internal policy development that have created a newly emerging collaboratives which redefine public/private relationships.
In the new Medi-Cal managed care system, pediatric preventive screening and treatment is the responsibility of the health plan. This has caused local health department-based pediatric service programs to re-examine their role in programmatic oversight and provider training. Health plan members who disenroll from the Medi-Cal managed care system face the challenge of coordinated care without a medical home. Health Net's Public Health Coordination Department promotes coordination with local health department-based pediatric service programs and makes policy recommendations to the state to improve access. In this new collaborative model, managed care plans and public health programs face the challenge of encouraging Medi-Cal members to seek and access pediatric preventive services.
This session will offer insights and applicable experience concerning the development of collaborative partnerships with local health departments in this new managed care system. These new partnerships provide a framework to address issues related to access and coordination of care for insured and uninsured children. The lessons learned will illustrate the importance of interagency communication, collaboration and determination to chart new paths in a rapidly changing environment.
Learning Objectives: 1) Understand the new challenges associated in outreaching and providing pediatric preventive services to health plan members and disenrolled members; 2) Articulate the role of a managed care organization in a newly emerging public-private collaborative; 3) Recognize the formidable tasks for developing public-private coordination of care arrangements with traditional public health programs
Keywords: Children's Health, Managed 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.