How to tap community resources for seniors. The HMO Workgroup on Care Management has issued a report on how plans and providers can access and work with community resources to meet the social needs of frail seniors. Find out what the panel suggests, and learn from the experiences of an Oregon medical group and a Georgia HMO.
Plan turns to providers to get pregnant Medicaid smokers to quit. After finding it tough to get pregnant Medicaid smokers to kick the habit on a plan level, a Wisconsin health cooperative relies on providers to persuade their pregnant Medicaid patients to stop smoking. See why some plans hope providers can make a difference.
Consider using encounter data for more than risk-adjusted Medicare or Medicaid payment. Providers with a New Jersey-based Medicaid plan and with a Medicare risk organization in Media, PA, expect to use encounter information to profile physicians and improve processes of care. Find out what they're planning.
Should providers take on Medicare pharmacy risk in today's environment? With drug costs shooting out of sight, experts say no. But what if you're already stuck? Mitigate your risk with these five tips.
Providers making inroads into managed Medicaid behavioral health. A new study shows that traditional public agencies and providers, not commercial managed care organizations, are running behavioral health programs in managed Medicaid. Even Medicaid HMOs with behavioral health benefits integrated in their program are turning behavioral health over to providers, putting them at full risk. See how one plan's behavioral health contractor is rising to the challenge.
Data File: Are provider organizations taking over Medicaid risk? The answer depends on the market, as demonstrated in these three analyses of enrollment trends in New York, Florida, and Ohio.
Data File: In this two-part column, take a look at 1999 and 2000 base capitation rates for several counties in Florida, a growing market for Medicare HMOs, and review Medicare HMO patient satisfaction survey results.
Tip of the Month: Watch how you select claims data. A consultant points out that providers using past Medicare claims data to determine which members have chronic conditions and how much they are likely to cost can make inaccurate estimates by using unfocused selection criteria.
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