Managed Care Systems and Emerging Infections Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary (2000) / Chapter Skim
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1 Introduction
1 Introduction
Pages 6-12
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From page 6... ...
Specifically, the fight against infectious diseases through prevention, surveillance, trea~nent, and research represents one of many areas in which managed care organizations have the potential to make marked improvements to a community's health. To make such a contribution, however, controls on reimbursements for health care expenditures must be carefully considered as they may pose an impediment to effective collaboration among managed care organizations and the public health community.
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From page 7... ...
Although several areas of health care in the present system are encountering difficulties, certain aspects of managed care, primarily its emphasis on prevention, should give the public health community reasons for optimism. Some of the benefits from an emphasis on prevention include the following: · the ability to deliver a range of clinical preventive services such as immunizations and screening for infectious diseases; .
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From page 8... ...
Legal entity formed or owned by hospitals and physicians to obtain payer contracts; physicians may retain ownership of their practices but agree to accept managed care patients under terms negotiated by the PHO. Organization that provides practice management, administration, and support services to individual physicians or group practices.
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From page 9... ...
Although trends indicate that managed care is making some progress in the fight against infectious diseases, they also indicate potential problems for both health care providers and consumers. The emphasis on controlling the costs of reimbursement for health care services can lead to an incorrect or missing diagnosis, underreporting of some infectious disease conditions, and inadequate follow-up.
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From page 10... ...
The need for collaboration is even more important in light of the reality that managed care organizations increasingly are becoming the major mode of health care delivery and financing for publicly funded care and the Medicaid and Medicare programs (CDC, 1995~. Many state governments have chosen managed care to provide health care services for individuals enrolled in state Medicaid programs, creating the "managed Medicaid" model.
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From page 11... ...
To improve heal outcomes, public and private purchasers of health care-particularly large employers, the Health Care Financing Administration, and state Medicaid agencies should form partnerships with public health agencies (CDC, 1995~. These new arrangements, combined with collaborative efforts with managed care organizations, could greatly improve community health while containing health care costs.
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From page 12... ...
Appendix A presents an overview of VA health care systems with regard to emerging infections and managed care. Representatives from managed care organizations, hospitals, government agencies, pharmaceutical companies, and academia were invited to give panel presentations moderated by Forum members.
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