Remaking Medicaid Managed Care for the Public Good

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

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.