1999 INVENTORY OF MANAGED CARE ACTIVITIES IN THE MATERNAL AND CHILD HEALTH BUREAU, HEALTH RESOURCES AND SERVICES ADMINISTRATION

 

Category of Activity

Organization and Point of Contact

Description of Project or Activity

Date

(Start/Finish)

Program Development

Division of Child, Adolescent, and Family Health (DCAFH)

Joe Zogby

(301) 443-6600

Community Integrated Service Systems (CISS) Projects: "Establishing a community based interagency services system for CSHCN in Los Angeles County". *

This capacity building effort is a response from L.A. County’s California Children Services (CCS) to a request from the State of California to assess the feasibility and cost-effectiveness of incorporating CCS-eligible children into the Medi-Cal managed care delivery system.

Oct. 1996-Sept. 2000

Program Development

Division of Child, Adolescent, and Family Health (DCAFH)

Joe Zogby

(301) 443-4393

Community Integrated Service Systems (CISS) Projects: "Realizing the potential for integrating managed care and community-based maternal and child health services in Philadelphia". *

The goal of this capacity building effort is to improve maternal and child health outcomes in Philadelphia by creating a system for the delivery of medical and support services that integrates community-based service providers into the managed care service for Medicaid recipients under the Health Choices program. An evaluation will assess birth outcomes among women on Medicaid on a yearly basis to determine whether women in Managed Care Organizations (MCOs) that have integrated Community Based Organizations (CBOs) into their service system have improved birth outcomes.

Oct. 1996-Sept. 2000

Program Development

Division of Perinatal Systems and Women’s Health (DPSWH)

John McGovern

(301) 443-8427

Healthy Start Program:

Fifteen or more Healthy Start projects are currently contracting or negotiating with managed care organizations to provide a wide variety of services, such as case management, case finding, health education, and technical assistance.

Ongoing

Program Development

 

Division of Perinatal Systems and Women’s Health (DPSWH)

John McGovern

(301) 443-8427

The Division is currently contracted with The Law Offices of Mark S. Joffe and Health Care Strategies Associates to develop a template as a tool to estimate cost savings in reducing cost associated with low birth weight births. The results of this finding will be used by all Healthy Start projects to be able to successfully negotiate future contracts with the managed care organizations. The template has been developed and it is being piloted.

 

June 1998-

February 2000

Program Development

Division of Service for Children with Special Health Care Needs (DSCSHN)

Ann Prendergast

(301) 443-9092

Managed Care for CSHN Initiative (Phase I):

27 grants will address critical issues related to managed care and its impact on CSHN and their families in 1994 for a three or four year period. These projects focused on four priority areas: (1) provider preparation, (2) consumer participation, (3) quality assurance, and (4) cost and utilization. See 1997 Conference Summary DSCSHN Managed Care Grantee Meeting and URL: http://www.hhs/gov/hrsa/mchb/cshcnmc.html

1994 -1999/2000

Program Development

Division of Service for Children with Special Health Care Needs (DSCSHN)

Ann Prendergast

(301) 443-9092

Managed Care for CSHN Initiative (Phase II):

10-15 grants will expand the Phase I initiative, which implements the National Agenda for CSHCN: Achieving the Goals 2000. The program is intended to establish partnerships between MCOs and public programs to develop and implement one or more of six options. See 1998 Guidance Application on URL: http://www.os.dhhs.gov/hrsa/mchb/guidance.htm#cshcn

July 1, 1998 - June 2002

Program Development

Division of Service for Children with Special Health Care Needs (DSCSHN)

Ann Prendergast

(301) 443-9092

National Policy Centers on Managed Care Policy and CSHN:

Two cooperative agreements with the Johns Hopkins University and the University of California San Francisco will develop a national policy center on managed care policy and CSHN. The policy center’s goal is to assure services for CSHN and assist in developing a strategy in response to State Child Health Insurance Program (SCHIP). See URLs:

http://www.ichp.edu/mchb/hsr/

http://www.familyvoices.org

June 1, 1997 to May 30, 2001

Program Development

Division of Service for Children with Special Health Care Needs (DSCSHN)

Ann Prendergast

(301) 443-9092

Managed Care for CSHCN Website Link:

Collaborative effort with Institute of Child Health Policy (Florida) and other groups to maintain a link on the MCHB website with information on CSHCN and Managed Care. URLs: http://www.hhs/gov/hrsa/mchb/cshcnmc.html

http://www.ichp.edu/

Fall 1997 - continuing

Research/

Studies/

Evaluations

Division of Perinatal Systems and Women’s Health (DPSWH)

Ann Koontz

(301) 443-6327

Environmental Influences and Perinatal Regionalization

It has been shown that infant mortality rates are improved when delivery and newborn care occur in facilities that offer the appropriate intensity of services needed by the mother and the infant. State MCH programs have noted that regionalized systems of perinatal services are breaking down as managed care grows and newer networks and arrangement of services are being devised. The John’s Hopkins University Women’s and Children’s Health Policy Center (WCHPC) is assessing the status of perinatal service systems and identifying the elements of regional systems that may be affected by environmental changes (such as managed care and other health reforms), both in the context of the local community and at the State or regional levels of care.

1998-2000

Research/

Studies/

Evaluations

Division of Perinatal Systems and Women’s Health (DPSWH)

Ann Koontz

(301) 443-6327

Women’s Interactions and Experience with the Health Care System

An initiative is underway to collect information from women to describe how women use health services and health information. Women who are enrolled in managed care plans will describe their access to OB/GYNs and other specialty services. Policy implications of these findings pertain to health insurance reform, designing health care delivery services and systems responsive to women’s needs, and improving provider education.

1998-2000

Research/

Studies/ Evaluations

Division of Research, Training and Education (DRTE)

Gontran Lamberty

(301) 443-2190

Research Agenda for the Maternal and Child Health Bureau FY 1997 and Beyond:

Joint ventures between the research and service programs of the Bureau with projects concerning issues on: Unintended Pregnancy, Genetic Services, Surveillance Systems, Health Services/Health Care Reform, Health Services/Systems, and Social Policy.

Ongoing

 

 

 

Research/

Studies/ Evaluations

Division of Research, Training and Education (DRTE)

Russ Scarato

(301) 443-0701

Aaron Favors

(301) 443-0392

Data Utilization and Enhancement Cooperative Agreements:

The collaboration with University of California, University of Illinois, and University of North Carolina has developed a consortium for the training , developing and promoting the use of analytic models which improve State and local capacity to use data through the use of multi-mode distance learning techniques.

 

1998 - 2001

Research/

Studies/

Evaluations

Division of Research, Training and Education (DRTE)

Aaron Favors

(301) 443-0392

Distance Learning Cooperative Agreements:

The collaboration between the University of California, at Berkeley, the University of Illinois, at Chicago and the University of North Carolina, at Chapel Hill has developed a consortium for the development and use of distance learning technology and techniques in a project that will develop and promote the use of analytic models that, for the current funding cycle, will improve State and local capacity to use data through multi-mode distance learning techniques.

See URLs: http://www.uic.edu/sph/mch_distance_learn

1998 - 2001

Research/

Studies/ Evaluations

Office of Data Information Management

Russ Scarato

(301) 443-0701

Data Utilization & Enhancement Grant Program:

The continuing initiative of 40 grantees assists States, local communities, and supporting entities like Managed Care Organizations to develop, adapt and integrate data models/systems, analyze economic costs, benefits and effectiveness, and use information technology in pursuit of maternal and child health.

1993-continuing

Research/

Studies/ Evaluations

Office of Data Information Management

Russ Scarato

(301) 443-0701

Graduate Student Internship Program (GSIP):

The GSIP provides interns with the opportunity to do work on epidemiology and economics of welfare reform and managed care. In addition it will address specific, defined, data or analytic issues as a part of States efforts to develop or enhance their MCH/CSHCN information systems.

1995-continuing

 

 

 

 

Research/

Studies/ Evaluations

Office of Data Information Management

Russ Scarato

(301) 443-0701

Monograph: Studies of Women’s and Children Heath - A Public Health Perspective

This publication focuses on managed care services and describes economic and cost effective principles that are useful in managing services to improve women and children's health.

It also reviews current analytical techniques in the economics and cost-benefit assessments of women and children's health services and present case studies of economic analysis of specific MCH interventions.

Products will be disseminated every six months through meetings and conferences.

 

1998 - 2000

Research/

Studies/ Evaluations

Office of Data Information Management

Russ Scarato

(301) 443-0701

Portable Electronic Health Records -Smart Cards:

MCHB, Treasury Department, and other federal agencies have funded the development of cards with a magnetic stripe, bar codes, or microchip technology which will store medical information of individual clients. The MCHB Smart Card is both an access device and a self contained storage of medical information. The Smart Card is designed to maintain information secure and confidential. This card promotes increase access to health care across the country for MCHB populations and migrant workers as all their pertinent medical data will be stored on the card. Smart Card pilot states are North Dakota, Wyoming, and Nevada. Design and development were completed in December 1997. The deployment and operations phases are scheduled for January 1998 through June 1999.

See URLs: http://www.westgov.org/hpp/

Jan. 1995 - Jun. 1999

Research/

Studies/

Evaluations

Office of Program Development (OPD)

Jacob Tenenbaum

(301) 443-9011

Cost and Quality Implications of Providing 12-Month Continuous Coverage for Children Under Public Health Insurance Mechanisms, Including Medicaid and CHIP

Ongoing evaluation study that will be used to assist the States in setting policy ; specifically to help Governors, State Legislators and Medicaid officials decide whether it would be cost-effective to implement the Balanced Budget Act option to provide 12-month continuous eligibility for Medicaid/CHIP children. The study will compare states providing continuous 12-month coverage for child health services and States with shorter coverage periods as to costs, and quality of care.

September 1999 -

June 2000

Technical Assistance

Division of Child, Adolescent and Family Health (DCAFH)

Carol Delany

(301) 443-5848

National Public Services Research Institute

Ted Miller

(301) 731-9891

Children's Safety Network - CSN Safety Economics and Insurance Center:

The Safety Economics and Insurance Center provides national and State level estimates of cost and incidence of child injury and violence, including benefit cost analyses of proven interventions, such as safety seats and bicycle helmets. The Center provides assistance to increase roles of third party payers, i.e. Medicaid and managed care organizations.

1990--continuing

Technical Assistance

Division of Child, Adolescent and Family Health (DCAFH)

Maria Baldi

(301)443-6192

National EMSC (Emergency Medical Services for Children) Resource center

Jean Moody-Williams

(301) 650-8063

White papers - Resource to managed care organizations, State and local governments and purchasers of care :

Based on the Emergency medical Services for Children (EMSC) managed care task force recommendations, a series 10 of white papers are currently under development centered on critical pediatric considerations in emergency medical services. The managed care white papers will serve as a resource to managed care organizations, State and local governments and purchasers of care when assessing the adequacy of pediatric emergency services in the managed care delivery system.

Ten topics will include:

1) 24-Hour Access to Emergency Care

2) Quality and Accountability for Children’s Emergency Medical Services

3) Reimbursement Issues for Emergency Care

4) Pediatric Practice Guidelines and Outcomes Research for Emergency Medical Services.

5) Continuity of Care in EMSC

6) EMSC Education and Training Considerations in Managed Care Environments

7) Injury Prevention in Managed Care

8) Definitions of Pediatric Emergency Care

9) Impact of Medicaid Managed Care on EMSC

10) EMSC Managed Care Issues for Children with Special Health Care Needs

11) Cultural Competency and EMSC and Managed Care

Papers available from the National EMSC Resource Center (301) 443-8063

Anticipated completion date for all papers:

December 1999

Technical Assistance

Division of Child, Adolescent and Family Health (DCAFH)

Carol Delany

(301) 443-5848

National EMSC Resource center

Jean Moody-Williams

(301) 650-8063

Manage Care and EMSC Publications:

A resource guide for EMSC titled -

"MANAGED CARE AND EMSC: A Practical Guide to Resources in Managed Care"

See URLs:

http://www.ems-c.org/products/frameproducts.htm

A fact sheet for Caring for kids in a managed Care Environment.

See URLs: http://www.ems-c.org/public/framepublic.htm

A brochure to help parents in selecting a health plan titled -

" When Your Child Needs Help in a Hurry"

Available from the National Resource Center (202) 884-4927

"EMS and Managed Care Bulletin" - A bulletin developed by EMS and managed care professionals to examine issues related to delivery of emergency care in a managed care environment.

"EMSC Managed Care Priorities" - A list of health care finance recommendations and priorities developed by a National EMSC Task Force. Provides program guidance in the area of managed care and recommends priorities for grantees and program participants.

Available from the National Resource Center (202) 884-4927

Published in 1997, Second printing due January 2000

Published 1998

Published 1999

 

Published 1999

 

Published September 1999

Technical Assistance

Division of Research, Training and Education (DRTE)

Shelley Benjamin

(301) 443-2190

National Center for Infant and Early Childhood Health Policy:

One of the goals of the Center is to determine how the health needs of infants and young children are being met by managed care organizations and then promote strategies for improving available health services, as well as increasing accountability for those services within managed care.

The Center intends to disseminate educational products in a number of ways, including written reports and briefs, a seminar series, national forums, and new electronic media including an Internet Web site.

Oct. 1996-Sept. 2001

Technical

Assistance

Office of Program Development (OPD)

Aimee Ossman

(301) 443-0879

Managed Care Resources Website

MCHB is funding a new website to provide managed care resources pertaining to maternal and child health populations. The website provides timely information on the Bureaus managed care activities, including trainings, events, publications and links to other resources.

See http://www.uic.edu/sph/cade/mch_managed_care

or look on the MCHB website under "What’s New."

Ongoing

Technical Assistance

Office of Program Development (OPD)

Aimee Ossman

(301) 443-0879

Managed Care Training Modules

On the Managed Care Resources website will be various training modules, including, but not limited to The ABC’s of MCOs for MCH, and Measuring Up: A BluePrint for Building Quality Assurance. Additional modules that are under development pertain to managed care contracting and the Pediatric Purchasing Specifications.

See http://www.uic.edu/sph/cade/mch_managed_care

or look on the MCHB website under "What’s New."

June 1999-June 2000

Training and Conferences

Division of Child, Adolescent and Family Health (DCAFH)

Stu Swayze

(301) 443-2917

Cooperative Agreement - National Institute for Health Care Management:

This agreement promotes public/private sector collaboration to improve children’s health and integrate Bright Futures concepts into managed care environments. The project has supported a series of small, interactive forums which address MCH issues and managed care. Recent forums have addressed outreach and specialized services for adolescents in managed care programs.

Meetings:

October 1999

Training and Conferences

Division of Child, Adolescent and Family Health (DCAFH)

Stu Swayze

(301) 443-2917

MCH Partnership for Information and Communication - American Association of Health Plans

This project disseminates HRSA’s Bright Futures model of health promotion to better serve the health needs of mothers and children served by managed care plans. Strategies employed include development of publications and written materials, elimination of barriers, assurance of access and quality of care, and improvements to health systems and infrastructure.

October 1997-

September

2002

Training and Conferences

Division of Research, Training and Education (DRTE)

Aaron Favors

(301) 443-0327

MCH Net-Link, Distance Outreach and Education:

In collaboration with the Institute of Child Health Policy, this multi-media project links computers, people and ideas for distance outreach and education. The MCH-NetLink project is designed to provide timely information and assistance to the maternal and child health community by making optimal use of today's technologies. This project provides a vehicle for the dissemination of managed care information to the targeted State Title V programs.

See URLs: http://www.ichp.edu/mchb/netlink/

Jan. 1993 - Jun 1998

Training and Conferences

Division of Service for Children with Special Health Care Needs (DSCSHN)

Ann Prendergast

(301) 443-9092

Tri-Regional Conferences on Managed Care for CSHCN:

In collaboration with DSCSHN and the Institute of Child Health Policy’s Center for Policy and Program Coordination, MCHB implemented workshops for stakeholders to address critical issues related to designing and implementing quality services for CSHCN in managed care systems.

The Eastern cluster met in Baltimore on June 21-23, 1999. The Eastern cluster includes regions 1, 2, and 3.

The Midwest Cluster will meet in Kansas City on September 5-7, 1999. The Midwest Cluster includes regions 5, 6, and 7.

The Western Cluster will meet in Phoenix, Arizona on November 14-17, 1999. The Western Cluster includes regions 8, 9, and 10.

Ongoing

 

 

 

 

 

* Abstract listed in the Community Integrated Service Systems: Abstract of Active Projects FY 1997, available from the MCHB Clearing House