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Maternity Care Coalition American Public Health Association – October 2001
Trends in Managed Care Services to Pregnant
Women
A Case Study of Maternity Care Coalition’s Experience in Southeastern Pennsylvania
American Public Health AssociationAtlanta, Georgia - October 2001
JoAnne FischerHeidi Worley
Maternity Care Coalition American Public Health Association – October 2001
Maternity Care Coalition Programs
MOMobile • Case-finding & referral
• Case Management• Follow-up
Supporting Pregnant, New
Parents
Early HeadStart• Intensive interventions
• Child development
Women’s Health, Children’s Futures,
• Research, Education, Advocacy
Healthy Living• HIV Prevention
•Community Education
Maternity Care Coalition American Public Health Association – October 2001
MOMobile Outreach
• 2012 New Families Enrolled
• 10 Sites
• 39 Site Staff
Maternity Care Coalition American Public Health Association – October 2001
MOMobile Families
• 20% Teens
• 59% African-American; 21% Latino/Hispanic; 10% White; 10% Others
• 66% on public benefits
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
Medicaid Managed Care in PA
Enrolled 1999Southeast (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 PA1,415,926
62% of total Medicaid population covered by managed care
*eligible population; program started 10/01/01
Maternity Care Coalition American Public Health Association – October 2001
Babies
• Total Southwest Births: 7,739
• Total Southeast Births: 14,075
Maternity Care Coalition American Public Health Association – October 2001
MCC History with Managed CareManaged Care in Pennsylvania • 10 years (1915 HIO waiver) • HealthChoices - mandated in Feb 1997• 75% enrolled voluntarily• Nearly 500,000 recipients enrolledMCC History with MCOs• Collaborative program sponsorship and pilots• Statewide Advocacy • Relationships with Decision makers MCC Market research• Focus groups 1996• Survey 1997• Campaign 1997
Maternity Care Coalition American Public Health Association – October 2001
Medicaid Managed Care Evolves in Southeast PA
Early years
New market
Learning curve
Capitation and Selection
Inclusive rates
Maturation
Mandatory participation
Experience
Special needs
population
Behavioral health carve out
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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
Maternity Care Coalition American Public Health Association – October 2001
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