What to do when your Medicare or Medicaid plan pays claims late. Doctors in New Mexico say they're going broke because health plans don't pay for months. But managed care plans with commercial lives aren't the only plans that pay claims late. Plans with Medicare and Medicaid lives also can have payment problems. Find out how the physicians in New Mexico are tackling the problem, and see what you can do to prevent it from happening to you.
Consider this model for PCP contracting. Provider organizations in Medicare and Medicaid often structure arrangements with their primary care providers that set up the organizations--and the doctors--to fail. An actuary from Milliman & Robertson in Seattle illustrates how to establish the right kinds of incentives for PCPs.
Data File: Some Medicaid managed care challenges and trends appear universal. A baseline study of the county-organized health system and two-plan managed Medicaid models in California reveals the unique models haven't escaped some of the problems and trends faced by more traditional managed Medicaid plans and providers across the country.
Are you meeting the needs of your minority Medicaid members? Cultural competency is becoming an issue in managed Medicaid as minority populations grow, and states require plans to meet the needs of non-English-speaking members. But researchers find that plans don't offer much help to providers. Get some expert advice on how you can better meet the needs of a multicultural population.
Community health center-owned plan reshapes itself to tackle expanding Medicaid population, but providers suffer growing pains. To rescue its ailing plan and boost enrollment, Neighborhood Health Plan of Rhode Island pursued the uninsured and the Children's Health Insurance Program (CHIP). Learn how the provider plan changed its image and added 5,000 members, and what challenges its owner health centers still face. And in a related story, find out why CHIP rapidly is becoming a potentially attractive market for Medicaid providers.
If your medical group is seeing specialty costs spiral out of control in Medicare, a reverse capitation arrangement may help. Paying primary care providers fee-for-service--and specialty providers capitation--may better align your group's incentives and promote better use of low-cost primary care services for seniors. See if the methodology is right for you.
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