Medicaid managed care and public health data.
In summary, there are a number of ways in which state public health data can be of value in the design of Medicaid managed care plans. At the level of the purchaser, such as a state Medicaid agency, public health data can assist in decision-making around pricing policy and can be useful in prioritizing interventions for those conditions that most severely affect the covered population. Quality assurance standards such as the HEDIS clinical performance measures can be used to define a baseline of prevention-oriented services or, by adding additional customized data points, to emphasize a particular service. From the standpoint of the managed care plan, public health data can be useful in understanding the needs of a community it serves or would like to serve and in estimating the prevalence of various conditions in that community that will influence the premium it will charge. Thus, there are multiple routes through which public health goals and priorities can be incorporated into managed care and can leverage the power of managed care to improve the public's health.
Rutherford
G W
GW
School of Medicine, University of California, San Francisco, USA. grutherford@psg.ucsf.edu
Backer
H D
HD
D003625:Data Collection; D016208:Databases, Factual; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000458:organization & administration* / Q000592:standards; D011634:Public Health / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States; D014798:Vital Statistics