Remaking Medicaid: Managed Care for the Public Good

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9780787940423: Remaking Medicaid: Managed Care for the Public Good
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More and more states are turning to managed care to restructure their Medicaid programs and help control spending.

This vital resource provides valuable information on the experience to date, as well as on the tasks to be faced as the states and other stakeholders go forward. It provides guidance for meeting the challenges to be faced in the conversion to this new system: transforming a fee-for-service program to capitation, contracting, creating accountability among providers and organizations, implementing quality management, setting up information systems, and marketing to diverse patient populations.

Written by an exceptional panel of experts, the book offers in a single volume a comprehensive roundup of the most current research and the best thinking on the critical issues.

Should be on the desk of every Medicaid administrator, health policy maker and managed care provider.
--Donna Checkett, chief executive officer, Missouri Care Health Plan, former Missouri Medicaid Director, and former chair, National Association of State Medicaid Directors

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From the Back Cover:

When it was first established in 1965, Medicaid provided health insurance for our country's neediest individuals and families. It was a cornerstone in the Great Society program. However, after thirty years of trying to keep pace with increasing numbers of impoverished citizens and escalating health care costs, Medicaid reached the breaking point. Today, more and more states are turning to managed care to restructure the program and help control Medicaid spending.

In Remaking Medicaid, a stellar panel of health care experts—many leaders in the field—provide much-needed guidance on the transformation of Medicaid and reveal how the application of national policy has been implemented at the state level. This landmark book presents a roundup of the best and most effective practices in state-based program development, planning, and operations.

Remaking Medicaid outlines the many challenges that health care policymakers and program managers must confront and presents information on strategic and operational planning from a variety of state-based programs. In this vital resource, the expert contributors:

  • Probe the important issue of setting health-based per-capita payments for managed care organizations
  • Describe how to use data to manage the performance of both managed care organizations and a state?s managed care program as a whole
  • Examine what can happen when large physician groups accept full-risk capitation
  • Provide straight talk about the Medicaid managed care experience to date and what to expect in the future
  • Reveal how officials at the longest-running statewide prepaid Medicaid managed care program built a successful program after a difficult start.
  • Outline the challenges and opportunities of caring for the chronically ill under prepaid arrangements
In addition, the book explores such important issues as defining quality management in Medicaid Managed Care and offers a penetrating analysis of Medicaid Managed Care contracts.

Written for health care executives, physicians, nurses, policymakers, health services researchers, and scholars, Remaking Medicaid offers a vision of the future to which conscientious policymakers and provider organizations, working together, can aspire.



About the Author:

STEPHEN M. DAVIDSON is associate professor of health care management and management policy at Boston University and director of research at John Snow, Inc., of Boston. He is coauthor of The Physician-Manager Alliance (Jossey-Bass, 1996). STEPHEN A. SOMERS is president of the Center for Health Care Strategies, Inc., in Princeton, New Jersey.

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Davidson, Stephen, Somers, Stephen A.
Published by Jossey-Bass (1998)
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Stephen Davidson; Stephen A. Somers
Published by Jossey-Bass (1998)
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