Improving Managed Health Care In California

This "from-the-trenches" guide can help you meet the challenges of forecasting a population's healthcare needs, building a provider panel, establishing financial incentives for providers, establishing information systems for managed care, negotiating managed care contracts, & managing utilization & quality.

The leaders of the State of Calif. have opened an important debate on health care, looking to solve the problem of its citizens who lack health care insurance. As California¿s single largest purchaser of health care, the Medi-Cal program is too big to be an afterthought in the debate on how to untie the knot of rising health costs, the lack of affordability, and the growing burden of cost-shifting on business. The sheer size of the Medi-Cal budget -- $37.7 billion and growing fast -- demands a smarter approach. Better by far for the state to focus on what the state is buying for its billions -- better for accountability to taxpayers and better for delivering promised health benefits to Calif.¿s poor and disabled, 6.6 million of whom are enrolled in Medi-Cal. Tables and graphs.

Highlighting performance improvement and business strategies throughout various health care settings, this text focuses on business drivers and management mechanisms, explaining when, how, and why information technology solutions are of value. Structured on three levels: Market Environment, Transformational Processes, and Enabling Technologies, the book describes the current state of the art of health care and the shape of things to come, and provides practical solutions and strategies for implementing applications of technology within the current context. It is thus an invaluable reference to the CEOs, chief information officers, senior executives, and board members who are shaping health care today and into the 21st century. It will equally appeal to healthcare administrators and managers, healthcare systems specialists, and students in advanced healthcare professional and academic programs.

Focuses on how Congress & the Administration can provide better information to Medicare beneficiaries when they are trying to select the right health plan to meet their health care needs. Contains statements from U.S. Senate Committee on Aging members as well as testimony from the Medicare Rights Center in New York City, the Institute of Medicine in Stanford, CA, the Health Benefits Service of the California Public Employees Retirement System, & a Medicare beneficiary. Includes General Accounting Office responses to Senate questions on the operations of the Health Care Financing Administration.

Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.