Promising practices: how leading safety-net plans are managing the care of Medicaid clients.
Health plans formed by safety-net providers serve large numbers of Medicaid beneficiaries. Through a series of case studies, we examined the care management tools used by leading safety-net plans. These plans do not rely on the coercive, command-style tools of managed care. They rely instead on tools that emphasize partnership with providers: sharing data about practice patterns, using provider profiles and financial bonuses to encourage particular practice patterns, and developing disease management programs that encourage patient compliance with treatment decisions that the plans make little effort to shape. The evidence suggests that these are promising practices but that even these leaders still have a long way to go.
Sparer
Michael S
MS
Mailman School of Public Health, Columbia University, USA.
Brown
Lawrence D
LD
Gusmano
Michael K
MK
Rowe
Catherine
C
Gray
Bradford H
BH
D019468:Disease Management; D017598:Efficiency, Organizational; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D017057:Medically Uninsured; D011209:Power, Psychological; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D017664:Uncompensated Care / Q000191:economics*; D014481:United States