Healthy Communities New Partnerships for the Future of Public Health (1996) / Chapter Skim
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Public Health and Managed Care
Public Health and Managed Care
Pages 13-30
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From page 13... ...
Outreach or community-based activities intended to improve access to personal health services or their utilization, however, are included. Public health agencies are often challenged to provide both types of services, but community organizations frequently help the public health agency 13
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From page 14... ...
Through this partnership, the Kiwanis, the county public health units, and the immunization program office have set an example that demonstrates the positive benefits that result when a community-based partnership works together to donate time, energy, and resources to improve the health of Florida's children. SOURCE: Based on information provided by Charles Mahan, Dean of the University of South Florida College of Public Health (former director, Florida State Department of Health and Rehabilitative Services)
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From page 15... ...
The committee's view, as developed in this section, is that if the proper kinds of partnerships between managed care organizations and governmental public health departments are developed, managed care can indeed make an important contribution to improving the health of the public. Accountability, Responsibility, and Quality Because it is responsible for delivering care to a defined group of enrollees, managed care makes possible, for the first time, accountability in terms of quality of care for populations, including access to care and heals outcomes.
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From page 16... ...
Both managed care organizations and governmental public health agencies have a philosophical emphasis on promoting health and preventing disease. Both address prevention and health promotion in a defined population.
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From page 17... ...
In addition, community service programs help to encourage innovative approaches to providing services to the patient population. SOURCE: Based on a presentation by William Berry, director, Center for Health Promotion, Group Health Cooperative of Puget Sound, at the February 22, 1996, meeting of the Public Health Committee.
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From page 18... ...
Individuals who are eligible for Medicaid but unfamiliar with managed care organizations may not understand how to access needed services. A strategy of partnering with both governmental public health agencies and community-based organizations, which have the skills and experience needed to work effectively with these vulnerable populations, could strengthen the entire health system's response to the needs of these special populations.
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From page 19... ...
personal health services traditionally carried out by public health departments (i.e., prenatal care, immunization services, family planning arid sexually transmitted disease [STD] clinics, and Early and Periodic Screening, Diagnosis, arid Treatment [EPSDT]
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From page 20... ...
The national movement toward managed care coupled with limited public funds for health programs will have a significant impact on the delivery of services provided by public health agencies, especially those that involve many providers and intervention points such as STD prevention and control. There are many opportunities and challenges for managed care to address STD issues effectively.
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From page 21... ...
Their role can include everything from offering advice about data and information systems, to developing training and education programs, even to fostering an advocacy role (Box 5~. In particular, governmental public health agencies can: · provide information about the health status, risks, and determinants of communities served by managed care organizations, which is vital for raising awareness and setting priorities even if the jurisdictions of the health agencies do not correspond exactly to the population covered by the managed care organizations; · participate with managed care organizations in planning and policy development related to voluntary collaborative actions or regulatory policy development; · provide services, such as case management and enabling services, to managed care clients; and · assist managed care organizations with assurance and oversight when working with state agencies with regulatory responsibility.
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From page 22... ...
Federal preventive health block grants are used to hold capacity-building conferences in specific areas such as immunization, STDs, alcohol and tobacco use, prenatal care, and violence. These conferences bring together representatives from local public health agencies, community health providers, managed care organizations, and other health service providers to analyze the community's needs assessment data.
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From page 23... ...
Local health deparDnents can organize as managed care providers and compete with private care plans for payer contracts or they can contract with managed care plans to provide specific services. Public health agencies can also assert their assurance function.
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From page 24... ...
an uninsured children's program; and (5) health education programs such as Healthy Breathing for smoking cessation, Healthy Lifestyles to decrease stress, Healthy Eating to assist in establishing healthy eating patterns, as well as avoiding obesity, and a fitness program.
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From page 25... ...
managed care system that integrates public health functions and services of a local health department with private-sector health plans. The Medi-Cal managed care contract stipulates that health plans will provide services to the Medicaid population and that the health department will administer the Medi-Cal program.
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From page 26... ...
The proliferation of organized health care delivery systems, which continue to provide care for an increasing number of Americans, has made it possible in some locales for governmental public health agencies to assure the provision of personal health services entirely within the private sector. How many elements of public health services private organizations can or should subsume remains unclear, but they can be considerable.
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From page 27... ...
State Medicaid agencies, usually separate from public health departments, also typically focus on fiscal rather than medical accountability dimensions. Recognizing the clear need for financial oversight, governmental public health agencies should increase their ability to oversee health care providers, with the goal of becoming coequal partners with insurance regulators and state Medicaid agencies, to ensure that the public's health is addressed in the regulation of public and private health care delivery systems (see Box 8~.
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From page 28... ...
· Promote equity among purchasers. In addition, during the 1996 legislative session, the relationship between the insurance commissioner and the health secretary was further strengthened by def~ninginterdependent roles for oversight of the Managed Care Organizations (MCOs)
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From page 29... ...
The need for common oversight to assure the organizational integrity from both the fiscal and quality of health services delivery perspective is necessary to assure optimal health care services delivery while maintaining the quality of the evolving health care enterprises for Maryland's employers and taxpayers. SOURCE: Based on information provided by Martin Wasserman, Secretary of the Maryland Department of Health and Mental Hygiene, 1996.
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