The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66643

Vergia Slade, BS, MHA, Public Health Programs Administration, Health Net of California, Inc, 11971 Foundation Place, D-1, Rancho Cordova, CA 95670, 916-935-1437, effie.ruggles@healthnet.com

The move of approximately two million Medicaid (Medi-Cal) beneficiaries from the traditional fee-for-service system into managed care organizations (MCOs) in California has caused local public health programs and MCOs to intersect on multiple program/service fronts. In the California Medi-Cal managed care model, pediatric preventive screening and treatment once provided by the local health departments, is now the responsibility of health plans. This has caused local health department-based pediatric service programs to re-examine their role and responsibilities for programmatic oversight and provider training.

Health Net, a MCO under contract to the California Department of Health Services administers pediatric services in seven counties, and works through its internal Public Health Programs Department to actively promote coordination with local pediatric preventive service programs. Enduring challenges such as disenrolling Health plan members and medical home coordination into other programs such as SCHIP continue to be a focus in the California landscape of healthcare. This has led to enrollment policy recommendations to the state pediatric preventive service program.

This session will offer insights and applicable experience concerning the promotion of pediatric preventive services within the Medi-Cal managed care system through collaboration with California’s pediatric preventive service program (CHDP). This acknowledged partnership has provided a framework to address communication and collaboration around coordination of care for insured and uninsured children. The lessons learned will illustrate the importance of interagency communication, agreements and collaboration to chart new paths in a rapidly changing health care environment.

Learning Objectives:

At the conclusion of the session, participants will:
• understand the role of pediatric preventive services in California's Medicaid managed care program;
• articulate the inherent challenges of a managed care and public health collaborative; and
• recognize the value of public-private partnerships to address pediatric preventive health care issues.

Keywords: Child/Adolescent, Public/Private Partnerships

Presenting author's disclosure statement:
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.