Maternity Care Coalition (MCC), a community-based organization serving low-income pregnant women, has learned lessons from its decade with Medicaid managed care organizations (MCOs) in Southeastern Pennsylvania. This case study reveals trends in MCO responsiveness to and inclusion of community agencies throughout the development of a managed care market.
The first section describes the advent of mandated Medicaid managed care when input was sought from community organizations. A flurry of market research, participation by consumers on advisory boards, attention to community relationships, and receptiveness to advocacy issues marked this period.
In the second period, MCC reinvented itself in the new environment. MCC conducted joint research projects with MCOs, received Medical Assistance provider status, developed contracts and created a database to collect HCFA billing data. MCC held contracts with all four regional providers and was nationally recognized for its work with MCOs, providing technical assistance to other agencies. Hopes for a new era of emphasis on prevention were high.
The third period reflects market maturation. In Pennsylvania, welfare reform created a crisis when Medicaid clients were improperly rendered ineligible because bureaucratic problems failed to de-link welfare and Medicaid. A lawsuit was brought against the Department of Public Welfare regarding special needs populations. The state reduced capitation rates while mergers and acquisitions were occurring within the industry. Newcomers with few community commitments replaced local administrators. Contracts with community agencies were reduced or eliminated. Advocacy activities press for managed care accountability, but relationships between the community and the industry have suffered irreparably.
See www.momobile.orgLearning Objectives: Discuss challenges to working on primary care issues in managed care environnment. Analyze role of community-based organizations in partnerships with the private sector.
Keywords: Managed Care, Community Participation
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.