L.A. Care Health Plan, the largest Medicaid HMO in the nation, has developed a community benefit model that recognizes the inapplicability of the narrow historical definition of hospital community benefit and the potential of local health plans to impact community health beyond their membership. This new model for a Community Accountable Health Plan defines the unique role local and not-for-profit health plans can play in improving community health, identifies a governance structure that emphasizes meaningful community input, and describes how programs and activities that confer community benefit are integrated into business and operational planning. As Schlesinger et al. have observed, many locally-governed, not-for-profit Medicaid plans are engaged in managed care practices that confer community benefit. Examples of these practices include information collection/dissemination, health promotion, re-education of health professionals, investment in local infrastructure, subsidized programs, partnering with the safety net, and community inclusion in governance. The model is viable and competitive but is challenged by the lack of a distinct identity among local Medicaid plans, which is needed to further encourage community benefit practices and ultimately improve the health of communities. In today's managed care environment, policy makers, opinion leaders, and media fail to recognize key differences between non-profit Medicaid plans with long-term commitments to low-income, vulnerable populations and commercial plans also serving this market as part of their product portfolio. The result has been declining political support and negative media attention defined by the managed care backlash not the access and quality achievements or community focus of such plans.
Learning Objectives: 1. Articulate a community benefit model for public and not-for-profit health plans. 2. Present a rationale for this community benefit model, and why it may differ from the historical hospital perspective. 3. Describe the challenges public and not-for-profit health plans face when implementing this community benefit model
Keywords: Community Health Planning, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: L.A. Care Health Plan (the Local Initiative Health Authority for Los Angeles County)
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment