Leading Medicaid Managed Care Plans


Book Description

Leading Medicaid Managed Care Plans examines leadership actions necessary to successfully operate a Medicaid managed care plan with emphasis on the relationship with the state Medicaid agency the health plan is contracted with. With appropriate operational and governance oversight, and with solid mutually respectful relationships with the state agency, Medicaid health plans are more likely to sustain success and prosperity for the long term. The approach of Leading Medicaid Managed Care Plans builds on key infrastructure elements that need to be in place when contracting with a state agency, and for overall success of the organization. It takes a pragmatic and methodical approach, interspersed with real-life examples of what to do for success and what actions to avoid that frequently lead to failure. This approach is different from most managed care books (Medicaid or otherwise) as those mostly focus on the process of the business (such as details around claims payment, or provider contracting) and ignore the role of the state Medicaid agency and its importance in retaining the contractual relationship. This book differs also on its emphasis on organizational foundational elements and strategic leadership skills necessary to sustain success. The author has years of experience in turning around failing Medicaid managed care plans and observing what they all had in common that contributed to those failures. One common feature was the deterioration of the relationship with the state Medicaid agency they were contracted with, and how close they all came to losing their multi-million dollar businesses. The purpose of this book is to educate and inspire managed care executives and senior leaders who operate Medicaid health plans and to help them understand what elements are needed for successful health plans and a sustainable relationship with the people directing the state Medicaid agency.







Managing Managed Care


Book Description

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.










Beyond Managed Care


Book Description

Written for health care leaders at all levels, Beyond Managed Care identifies and assesses the key factors most likely to influence the future market for health care services-such as consumer empowerment through the Internet and the increasing demands of the aging baby boomer population-and shows providers what adjustments can be made in order to thrive in this emerging environment. The authors analyze the factors driving health care costs such as changing demographics, new medical technology, genetic and new drug research, and payment system models. The book clearly shows that organizations that are able to take organizations to the next value-added level--by providing quality, access, service, innovation, and lower costs--will be the winners.




The Great American Rip-Off


Book Description

This book gives the reader a look at the complicated U.S. health care system through the eyes of a consumer. It explores two key questions: Why, with all of the resources that have been devoted to solving the health care crisis, does the situation continue to deteriorate? And, what, exactly, could be done differently this time to turn the situation around? The author examines obstacles that have stood in the way of health care reform in the past - including politics, government red tape, profit-driven providers, moneyed lobbyists and special interest groups and even, our own consumer "entitlement mentality" - and challenges the reader to envision a scenario in which innovation in health care might be possible. The author argues that consumers are the key to forward progress on health care: we'll only see consumer-driven solutions when enough people demand them. This book is a challenge to consumers to speak up and hold our leaders in the medical community, the government and corporate America accountable for developing solutions that work for us. Susan M. Finley is a small business owner and marketing strategist. She began her career as a bank product manager, and in 1994 co-founded Michaelson Kelbick Partners Inc. (MKP), a firm specializing in marketing and communications for the financial services industry. Over the course of a decade, the agency managed marketing communications for some of the largest bank mergers in recent history. In 2003, she left MKP (now renamed mkp communications, inc.). Her knowledge and understanding of the complicated U.S. health care financing system comes from a three-year research and consulting project, started in the hopes of serving as a catalyst for consumer-driven changes in health care. She lives in North Carolina, where she and her husband have recently founded Finley and Finley, LLC, to continue their research on potential avenues for innovation in the health care and financial services industries.