Successful Medicaid managed care organizations: it is not an oxymoron.
Success as a Medicaid health plan is achieved by those plans with a clear understanding of Medicaid program requirements. Executives of Medicaid health plans identify four common elements that result in winning plans: (1) Leadership must have significant experience with, or otherwise develop knowledge of, the Medicaid program's regulations and populations covered; (2) the plan must have an internal managed care culture and system that integrates finance, operations, and medical management; (3) management must have access to highly specialized information and data analysis capability; (4) leadership must have well-developed relationships with key stakeholders. While these elements seem intuitive, health plans often enter the marketplace without needed groundwork firmly in place.
Goodman
J
J
Operations and Government Programs, Schaller Anderson, Incorporated, Phoenix, Arizona, USA.
Nye
C H
CH
D003628:Database Management Systems; D006801:Humans; D007373:Interinstitutional Relations; D007857:Leadership; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D015279:Organizational Culture; D013221:State Health Plans / Q000458:organization & administration*; D018511:Systems Integration; D014481:United States