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Trends in Managed Care Services to Pregnant Women

Trends in Managed Care Services to Pregnant Women. A Case Study of Maternity Care Coalition’s Experience in Southeastern Pennsylvania. JoAnne Fischer Heidi Worley. American Public Health Association Atlanta, Georgia - October 2001. Maternity Care Coalition Programs. MOMobile

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Trends in Managed Care Services to Pregnant Women

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  1. Trends in Managed Care Services to Pregnant Women A Case Study of Maternity Care Coalition’s Experience in Southeastern Pennsylvania JoAnne Fischer Heidi Worley American Public Health Association Atlanta, Georgia - October 2001

  2. Maternity Care Coalition Programs • MOMobile • Case-finding & referral • Case Management • Follow-up • Early HeadStart • Intensive interventions • Child development Supporting Pregnant, New Parents • Women’s Health, • Children’s Futures, • Research, • Education, Advocacy • Healthy Living • HIV Prevention • Community Education

  3. MOMobile Outreach • 2012 New Families Enrolled • 10 Sites • 39Site Staff

  4. MOMobile Families • 20% Teens • 59% African-American; 21% Latino/Hispanic; 10% White; 10% Others • 66% on public benefits

  5. MOMobile Case Management, Education and Family Support • 3,339 Families Served • 21,951 Education Contacts • 45 Parent Outreach Meetings, 560 Participated • 3,301 Home Visits • 5,281 Referrals

  6. Negotiating Health Insurance • Last year, assisted 241 & signed up 68 families for CHIP • Refer uninsured and immigrant families to federally funded health centers • Assist families on how to negotiate mandated managed care & plan contractor changes

  7. Medicaid Managed Care in PA Enrolled 1999 Southeast (Philadelphia 5 county) 454,000 Southwest (Pittsburgh 10 county) 250,000 Lehigh/Capital(Allentown 10 county) 167,000* Total Medicaid managed care PA 871,000 Total Medicaid population PA 1,415,926 62% of total Medicaid population covered by managed care *eligible population; program started 10/01/01

  8. Babies • Total Southwest Births: 7,739 • Total Southeast Births: 14,075

  9. Southeast PA 28% 24% 48%

  10. MCC History with Managed Care • Managed Care in Pennsylvania • 10 years (1915 HIO waiver) • HealthChoices - mandated in Feb 1997 • 75% enrolled voluntarily • Nearly 500,000 recipients enrolled • MCC History with MCOs • Collaborative program sponsorship and pilots • Statewide Advocacy • Relationships with Decision makers • MCC Market research • Focus groups 1996 • Survey 1997 • Campaign 1997

  11. Early years New market Learning curve Capitation and Selection Inclusive rates Maturation Mandatory participation Experience Special needs population Behavioral health carve out Medicaid Managed Care Evolves in Southeast PA

  12. MCC Heyday • MOMobile clients demand provider inclusion • MCC contracts with all 4 Medicaid MCOs • Contracted services vary and include: • Outreach, Case Finding & EPSDT Enrollment • Assessment, Home Visiting & Case Management • MCC builds capacity for electronic data and claim submission • Total MCO revenue FYE 6/1999: over 100,000 (4% of budget) • MCC is national model for community based organizations contracting with MCOs

  13. MCC Tried to Make It Work Necessary but not sufficient • Good reputation and customer satisfaction and demand • Significant number of members in the region • Strong infrastructure • MIS reporting • Financial billing capacity • Direct services protocols & QA

  14. Upstaged by welfare reform • Families confused, in denial, panicking • Caseworkers misinformed, hesitant to impart information • Role of public sector not fully defined & coordinated • Regional media market not providing county-specific information for consumers • MA consumers were incorrectly dropped because they were linked to welfare rolls

  15. MCC’s Response • Developed brochure; 5 languages, distributed 20,000 • Assisted City with urgent, targeted outreach • With Legal Services, challenged TANF work requirements for teen parents in school • With Women’s Law Project, advocated for State to change domestic violence exemption rule

  16. Upstaged by CHIP • 1997 – SCHIP legislation passed • Pennsylvania becomes national model for private HMO based CHIP plan • PA develops Reaching Out – CHIP outreach initiative MCC Responds • MCC key in RWJ Covering Kids pilot • MCC trains staff and develops protocols and database enhancements for CHIP enrollment

  17. Lessons Learned • Interest from MCOs in early stages of market development • Commitment to community shifted, as did the leadership, ownership, relationships and visibility of plans • When the going gets tough, community groups go first • Public health not an MCO priority

  18. MCC’s Agenda Moving Forward • Continued commitment to Medicaid sponsored outreach and case management services • CBOs and community health workers can help beyond enrollment – essential to reaching most isolated groups • Understanding of public benefits and system navigation a major strength of CBOs • More dialogue necessary within PA and nationally

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