title: Building public health goals into the purchasing process: the Missouri Medicaid agency as purchaser.
abstract: BACKGROUND
  As managed care radically changes the medical care environment, public health leaders are under increasing pressure to focus more on core public health functions and less on personal health services. As public health re-evaluates its key strategies, it can take advantage of its strategic role in purchasing medical care to forge new partnerships that benefit its constituents.
  
  
  METHODS
  Specific roles for public health in medical care purchasing are discussed. The state of Missouri is used as an example of successful strategies for positioning public health as a leader in the managed care environment. Key strategies include increasing influence in contracting; selecting and reporting of key health status indicators; promoting use of population-based data files; taking leadership roles in government-sponsored insurance programs; and assuring stability of critical health conditions during managed care transitions.
  
  
  CONCLUSIONS
  Public health has unprecedented opportunities to develop new methods for improving health status. Public health's well-developed scientific principles and methods, combined with strategic leadership, will position the discipline in the forefront of the dialogue about our nation's health system into the next century.
authors.affiliation: Department of Family and Community Medicine, University of Missouri Hospitals and Clinics, University of Missouri-Columbia, 65212, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Kivlahan
authors.forename: G H
authors.initials: GH
authors.lastname: Land
mesh_terms: D003284:Contract Services / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D008923:Missouri; D010043:Outcome and Process Assessment, Health Care; D011635:Public Health Administration; D019984:Quality Indicators, Health Care; D013221:State Health Plans / Q000458:organization & administration; D014481:United States