Sound advice from a survivor. Yellowstone Community Health Plan in Billings, MT, is one of the few rural Medicare Choices demonstration programs still operating. Leaders of this provider-sponsored HMO reveal what all providers need to know about the universal problems in Medicare risk and transitioning into Medicare+Choice.
Case study: A pediatric provider system seeks control in managed Medicaid. By creating its own provider network, and making some unusual contracting arrangements, Cook Children's Health Care System in Fort Worth, TX, has lowered utilization and even paid bonuses to physicians under its first full-risk contracts with three Medicaid plans. See how this system's providers set themselves up to succeed.
Seeing repeated ER visits and hospital admissions by your Medicare risk seniors? Try using social workers to case manage them. Two IPAs in California reveal how using a social work case management model can help reduce utilization--possibly up to 50%.
Learn some lessons in rural managed Medicaid from a provider-owned plan. Upper Peninsula Health Plan, based in Marquette, MI, discovered that introducing managed care to providers through their own rural Medicaid plan is full of surprises. Find out what to expect--and what to avoid--from a plan that's learning the hard way.
Data File: Here's some benchmark data on Medicare lengths of stay and average hospital charges from the Louisville, KY-based Data Advantage Corp. Providers can use the data to help determine their competitiveness and better assess discounts sought by Medicare risk plans.
Want your Medicaid members to get their vaccinations and well-child visits? Try encouraging them with an incentive system that offers something they can use, like children's clothing. Arizona Physicians IPA Inc., a Phoenix-based Medicaid managed care organization, uses clothing exchanges to encourage preventive utilization and give members access to community outreach programs.
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