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Health Insurance/Managed Care Tools
- Financing and Reimbursement Strategies in Managed
Care, a glossary for consumers. Developed by
the National Center on Financing for CSHCN. Glossary
- How to Approach Carriers about Increasing
Reimbursement for
- Quality Improvement
Activities.
Tip Sheet
Evaluating Managed Care Plans For Children With Special
Health Needs: A Purchaser's Tool
This evaluation tool will assist purchasers in selecting and
evaluating the capacity of health plans to serve children,
with or without chronic conditions. policyweb.ichp.ufl.edu/ichp/purchaser/Default.htm
The Medicaid Resource Book
"This reference book describes four pivotal aspects
of how the Medicaid program operates -- who it covers, what
it covers, how it is financed, and how it is administered.
It was written to assist the public and policymakers in
understanding the structure and operation of the Medicaid
program"
www.kff.org/content/2003/2236/
Pediatric Managed Care Training Module Now Available
The George Washington University Medical Center's Center
for Health Services Research and Policy (CHSRP) recently
developed a pediatric managed care training module for use
by all payers, providers, state and local health departments,
and advocates who are concerned with the health care of
children. The module is a learning course to help interested
parties learn about managed care contracting for pediatric
services, as well as write and negotiate contracts to ensure
that children, particularly Medicaid and SCHIP children,
receive quality care.
The link to the Training Module is provided below, and
for more information on CHSRP's work on managed care contracting,
please visit the managed care section of CHSRP's Web site
at: www.gwumc.edu/sphhs/healthpolicy/chsrp/managed_care.html
Planning Culturally and Linguistically Appropriate Services:
A Guide for Managed Care Plans:
www.ahrq.gov/about/cods/planclas.htm
To address shifting demographic trends in health care, this
guide offers health plans an approach to defining the needs
of multi-ethnic members and developing culturally and linguistically
appropriate services for them.
The Centers for Medicare & Medicaid Services (CMS) commissioned
this guide, as well as a companion guide, Providing Oral
Linguistic Services (select for Summary). Both were developed
by a contractor of the Agency for Healthcare Research and
Quality (AHRQ).
The Shared Responsibilities Toolkit: Tools for Improving
Quality of Care for Children with Special
Health Care Needs (CSHCN) is available on the New
England SERVE website This publication (2002, 75 pages)
is designed to focus the attention of health plans on CSHCN.
The Toolkit includes an 8-page introductory booklet, and
fifteen additional tools that can help plans identify CSHCN
and collaborate with families, providers and Title V programs
to improve systems of care.
The Shared Responsibilities tools are designed to be easily
adapted for use by:
- any health plan;
- provider group;
- purchaser; or
- state agency working in partnership with health plans.
The Identify section of the Toolkit includes a rationale
for why health plans should invest in identifying this population.
Four sample tools for identifying children with special
health care needs are included, as well as references on
how to get additional information and support in using these
tools.
The Collaborate section of the Toolkit includes survey formats
and resources designed to assist health plans to build partnerships
with families, providers, and state organizations that are
also involved in providing care for this group of children.
The Improve section of the Toolkit includes examples of
best practices at the health plan level, a checklist for
health plan policies and procedures that can support serving
CSHCN, and a set of measures that can be used to assess
a health plan’s readiness to focus on this population.
Shared
Responsibilities Toolkit:Tools for Building Partnerships
to Improve Health Care Financing for CSHCN 
Susan G. Epstein. May 17, 2003.
Improving Managed Care for Children with Special
Needs - A Best Clinical and
Administrative Practices Toolkit
As health plans across the country increase enrollment of
Medicaid and SCHIP
beneficiaries, the challenges of providing consistent, high
quality care and the need
for defined and measurable quality improvement expand significantly.
The Best
Clinical and Administrative Practices (BCAP) initiative
was created by the
Center
for Health Care Strategies (CHCS) to develop, document,
and spread best practices
among Medicaid health plans. This toolkit reflects the experiences
of the Improving
Managed Care for Children with Special Needs workgroup,
a group of 11 health plans
and a primary care case management (PCCM) program that collaborated
over 24
months to develop, pilot, and refine best practice models
for serving this population.
Last updated
July 25, 2008
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