Thursday, December 09, 2004

A win-win for health-care providers and consumers
Story in the December APA Monitor - "After years of legislative efforts, coalition building and discussions with managed-care officials, psychologists in Rhode Island--and their clients--are seeing the fruits of their labor. In August, they gained major concessions from Blue Cross/Blue Shield in their state. The company increased mental health benefits to 30 visits--an increase of 10 visits--dropped outpatient care management requirements and raised psychologist provider fees. The changes don't just benefit providers; they also assist consumers by giving them more available, accessible, comprehensive psychological services, notes Peter Oppenheimer, PhD, past-president of the Rhode Island Psychological Association "  
  

Medicaid Managed Care: Access and Quality Requirements Specific to Low-Income and Other Special Needs Enrollees
A GAO report in Adobe Acrobat format - "The use of managed care within Medicaid, a joint federal-state program that finances health insurance for certain low-income families with children and individuals who are aged or disabled, increased significantly during the 1990s. By 2003, 59 percent of Medicaid beneficiaries were enrolled in managed care, compared with less than 10 percent in 1991.1 Medicaid managed care, under which states make prospective payments to managed care plans to provide or arrange for all services for enrollees,2 attempts to ensure the provision of appropriate health care services in a cost-efficient manner. However, because plans are paid a fixed amount regardless of the number of services they provide, managed care programs require safeguards against the incentive for some plans to underserve enrollees, such as by limiting enrollees’ access to care. Access is also affected by other factors, such as physician location and willingness to participate in managed care plans."