|
||||||||||||||||||||||||
|
||||||||||||||||||||||||
| Policy Development |
| Research and Evaluation Studies |
| Information Dissemination |
Technical Assistance and Training
Third Party Reimbursement Training and Technical Assistance Program
Assist HRSA grantees and subgrantees who bill or should be billing third party sources such as Medicaid, Medicare, S-CHIP, and private insurance in improving their third party billing, coding and collections practices so that HRSA grant funds can go further in caring for those with no form of health insurance coverage. A day and a half training program will be provided in all 50 states over a three-year period (twice in larger states, 57 in all). Technical Assistance will be available following the training and will include print and web based materials, telephone consultations, and on-site visits by experts in third party reimbursement under contract to HRSA.
Web: www.hrsa.gov/tpr
TPR Technical Assistance: 1-866-877-8439HRSA Managed Care and Health Services Financing Technical Assistance Center (MCTAC)
The HRSA Managed Care and Health Services Financing Technical Assistance Center (MCTAC) is a national resource of managed care expertise for HRSA grantees and safety net providers (i.e., public health departments, public hospitals, community health center plans). MCTAC offers a customer-focused approach to technical assistance and training with high quality, responsive and integrated services.
Over the last year, more than 140 HRSA grantees and safety net providers have received technical assistance from MCTAC. MCTAC co-sponsors workshops at both state and local levels that address the managed care needs of specific customers. In addition, a full range of services is available: training sessions; on site technical assistance, online, or by telephone; technical publications and review of managed care contracts. MCTAC is managed by the HRSA Center for Health Services Financing and Managed Care (CHSFMC).
The Managed Care and Health Services Financing Technical Assistance Center (MCTAC) offers workshops in various topics including:
Capitation Management Workshops:
Basics of Managed CareContract Review and Contracting Workshops:
Medicaid Contracting
Medicare Contracting
Negotiating a Managed Care Contract
Public Health and Managed CareCultural and Linguistic Competence Workshops:
Building Cultural and Linguistic CompetenceFinancial Analysis and Management Workshops:
Financial Monitoring of Managed Care Contracts
Rate/Reimbursement Adequacy and Financial AnalysisMedical Management/Utilization Review Workshops:
Changing Clinical Systems to Survive in Managed Care
Curriculum Changes for Health Professionals
Disease Management
Effective Managed Care Strategies for Faculty
Practice Plans
Health Employer Data Information Systems (HEDIS)
Medical Management in a Managed Care
Environment
Pharmacy ManagementManagement Information Systems Workshops:
Management Information SystemsPublic Health and Managed Care:
Building Relationships Between Public Health Agencies and Managed CareStrategic Planning and Positioning Workshops:
Developing Vertical and Horizontal Provider Networks
Meeting the Needs of Special Populations
Impact of Managed Care on the Homeless
Populations and their Health Care
Preparing for Managed Care: Strategies for HIV/AIDS providers, Service Organizations, and State/Local Agencies
Risk Adjustment for High-Risk, Special Needs PopulationsFor complete information on the workshops offered please visit the HRSA Managed Care and Health Services Financing Technical Assistance Center website at www.jsi.com/hrsamctac
Below are several examples of on site technical assistance and programs MCTAC has supported and co-sponsored with others.
Area Health Education Centers and Cultural Competence Assessment
A Massachusetts AHEC recently held their Annual Institute on Cultural Competency conference. MCTAC co-sponsored a workshop that offered participants the opportunity to explore issues and strategies of cultural competence assessment at the organizational level.Area Health Education Centers (AHEC) Partnership
MCTAC and the Tufts Health Care Institute are collaborating with AHEC programs and centers to co-sponsor managed care training for health professionals. Faculty with expertise in various areas of managed care will conduct the training.Challenges and Opportunities for Securing Reimbursement: Relationships with Payors, Including Managed Care Companies
The Health Resources and Services Administration (HRSA) together with the National Assembly for School Based Health Care, is offering school-based health centers training and technical assistance in third party reimbursement and related practice management issues. For further information go to www.nasbhc.org
Cultural Competency and Managed Care
On May 30, 2002 a National Conference was held in Chicago, Illinois where cultural competency and managed care were discussed. Participants were provided with culturally and linguistically appropriate services.Family Practice Residency Program and Effective Cultural Competence Programs
MCTAC co-sponsored a half-day workshop on diversity and cultural competency for family practice residents and faculty. The workshop focused on identifying practitioner misconceptions about different cultures and developing skills essential for effective cultural competence programs.HIV/AIDS Providers: Negotiating and Marketing Managed Care Contracts
MCTAC co-sponsored a one-day workshop for Ryan White Title III providers. The workshop focused on marketing and negotiating managed care contracts.Managed Care Contracting for an Agency Serving Children with Special Health Needs
MCTAC provided technical assistance to a home health agency serving children with special needs. MCTAC secured a consultant familiar with the home health agency's health care environment and competition. With the consultant's hands-on help, the agency identified the appropriate MCOs, made the contacts, and secured at least one major MCO contract.Migrant Health Center: Meeting Managed Care Provider Criteria
A migrant primary care center sought MCTAC assistance to be able to become a Medicaid managed care primary care provider. MCTAC provided a consultant to help the center assess its internal and external environment and determine its potential for meeting provider criteria. MCTAC services enabled the center to focus on a course of action to prepare for future provider status.Public Health and Managed Care: Opportunities for Collaboration
MCTAC co-sponsored a meeting between a public health department and Medicaid managed care organizations. An experienced managed care consultant guided the group in exploring the opportunities for collaboration and provided multiple illustrations of successful joint initiatives. As a result, joint projects are being developed in such areas as immunizations and prenatal care outreach.To access services and obtain further information on HRSA's MCTAC:
Call toll-free: 1-877-832-8635
Fax: 703-528-7480
E-mail: hrsa_mctac@jsi.com
Web site: www.jsi.com/hrsamctacHRSA Bureaus/Offices are also involved in managed care activities and provide managed care technical assistance to their grantees. To find out more about other Bureau/Office managed care activities and technical assistance, please click the links below:
Bureau of Primary Health Care
Maternal and Child Health Bureau
HIV/AIDS Bureau ServicesTechnical Assistance on Reimbursement for School-Based Health Centers
School based or school linked health centers (SBHCs) are now providing primary care services in approximately 1,300 sites across the country serving more than a million children. Yet, they face significant challenges in assuring adequate financing for their services, maximizing appropriate billing and coding systems. To address these needs, the Managed Care and Health Services Financing Technical Assistance Center (MCTAC) in cooperation with the National Assembly of School Based Health Centers is offering SBHCs training and follow-up technical assistance in third party reimbursement, managed care contracting, and related practice management issues.
One-day training for centers and their sponsoring agency administrators has been presented in a number of states. It continues to be available in additional states. The session focuses on identifying payers, as well as what SBHCs need to do to position themselves to successfully participate in manage care networks. It is conducted by experts in the field of organizational finance and managed care contracting who all have senior level experience in reimbursement arrangements and processes. Prior to the training sessions, the faculty discusses the needs and characteristics of the specific audience with the requesting party so that the material can be tailored appropriately for maximum benefit.
Pharmacy Management Regional Conference and Publication
The HRSA Managed Care and Health Services Financing Technical Assistance Center and the National Public Health and Hospital Institute (NPPHI) will hold an invitational conference for safety net providers to share best practices and information regarding pharmacy management for patients enrolled in Medicaid managed care plans, including HIV/AIDS patients. A publication is under development in addition to a self-assessment tool for pharmacy and clinical providers to assist in developing systems to assure feasibility and manage costs with Medicaid managed care.
A regional meeting, "Managing the Medicaid Pharmacy Benefit," was held in Los Angeles, California on May 10, 2000. This was a collaborative effort with the National Public Health and Hospital Institute (NPPHI), the Managed Care and Health Services Financing Technical Assistance Center (MCTAC), the California Health Care Foundation, and the Academy of Managed Care Pharmacy.Curriculum Guide on Managed Care
Tufts Health Care Institute (THCI) is developing an instructional guide to support and facilitate the training of medical residents for practice in the managed care environment. The "Curriculum Guide on Managed Care," is funded by HRSA through the Bureau of Health Professions and the Center for Health Services Financing and Managed Care. The guide uses a series of teaching sessions in related to clinical practices and managed care organizations. It will contain lesson plans; content summaries in slide format, cases and practice scenarios, references, quizzes, and other instructional materials.
The guide is scheduled for completion in fall 2002. For information and updates on the availability of the guide, contact www.thci.orgFellowship Program on Health Services
The Center for Health Services Financing and Managed Care and the Bureau of Health Professions offered the Fellowship Program on Health Services this summer. The American Medical Student Association (AMSA) coordinates the program, in collaboration with the Tufts Health Care Institute that develops and conducts weekly seminars.
The fellowship is a seven-week program designed to introduce selected physicians-in-training to principles in health care delivery and management, including providing health services to underserved populations. The program combines an orientation in the US health care system with weekly seminars, run by Tufts Health Care Institute, and field placements in community health centers or health plans in the Boston, Massachusetts area. Students will be expected to develop and research a short paper on a topic of interest to themselves and their placement site. A stipend to cover living expenses will be provided to the fellows.
Since 1999, students have been selected to participate in the Fellowship Program on Health Services. Placements include community health centers and managed care organizations, such as Harvard Pilgrim Health Plan, Blue Cross/Blue Shield of Massachusetts, Tufts Health Plan, East Boston Community Health Center, and Fenway Community Health Center.
To obtain more information about this program visit the AMSA website at http://www.amsa.org/programs/mcfp/mcfp.cfm
Policy Development
Regional Managed Care Meetings with State Medicaid Agencies Regarding Current Issues of Concern to State and Federal Organizations Serving Low-Income and Vulnerable Populations
HRSA, in collaboration with the American Public Human Services Association (i.e.: Medicaid Directors), has sponsored and will continue to sponsor a series of regional meetings on issues of mutual concern to state Medicaid Agencies and HRSA programs. For each state, these meetings bring together State Medicaid Directors and HRSA funded programs regarding the development of service delivery systems, which ensure continuity of care for vulnerable and underserved populations.
The regional meetings include issues that are particularly relevant for special needs populations such as children and people living with HIV/AIDS. This year's topic is adolescent health care issues and access to services for low-income adolescents.
Purchasing Specifications for Public and Private Purchasers of Managed Care Services
The Center for Health Services Financing and Managed Care continues to work with the Center for Health Services Research (CHSRP) at George Washington University, Centers for Disease Control and the Substance Abuse and Mental Health Services Administration on the development of Purchasing Specifications. The specifications provide options for language on key contracting issues for both public and private sector purchasers as they prepare their purchasing agreements with managed care organizations.
Please visit the website for the Center for Health Services Research and Policy at George Washington University.
Purchasing Specifications available:
* Pediatric Purchasing Specifications (funded by HRSA)
* HIV/AIDS Purchasing Specifications (funded by HRSA)
* Immunizations
* Cultural Competency
* School-Based Health Centers
* Sexually Transmitted Diseases
* Lead Screening
* Tuberculosis
* Dental Care
* Access to care (funded by HRSA)
* Care for persons experiencing homelessness (funded by HRSA)
* Cultural Competency (funded by HRSA)
* Memoranda of understanding between managed care organizations and public health departments
* Services for adults with mental illness and addictions disorders
* Reproductive health
* Diabetes
* Asthma
* Data and information
* Pharmaceuticals and pharmaceutical servicesTo access the purchasing specifications listed above, please visit the Sample Purchasing Specifications page of the Center for Health Services Research and Policy website.
Research and Evaluation Studies
Current Issues in Managed Care for Safety Net Providers
The purpose of this study with George Washington University is to study existing Medicaid managed care and primary care case management contracts to identify areas where the needs of populations served by HRSA funded providers could be better met and to develop approaches in addressing those needs. This study will also provide an examination of free-standing SCHIP managed care contracts.
Development of Performance Measures Regarding Access to Behavioral Health Care Services
The purpose of this study with the National Committee for Quality Assurance is to develop a set of performance measures regarding access to behavioral health care services. This will result in measures of access to behavioral care services that will have multiple uses. Measures on this topic are currently unavailable and therefore this activity would provide new policy tools to assure the availability of quality behavioral health care for patients seen in managed care settings.
Racial Disparities in Health Care Outcomes
Based at Michigan State University, this study builds upon an on going study funded by the Commonwealth Fund. Its purpose is to assess the feasibility and potential value of a health care report card that provides performance and outcomes information about racial and ethnic disparities in health care. The demonstration includes several health plans owned by community health centers as well as others that serve a large Medicaid population. The intent is to produce measures that can be used as benchmarks for comparative purposes and as valuable tools for improving quality and reducing health care disparities. A set of final reports will include a list of quality measures, a data collection manual, results of the data collection, and policy recommendations pertinent to serving the needs of a diverse population.
Information Dissemination
The Center's Newsletter (Notes) provides technical assistance and training information to HRSA grantees and providers to enhance their understanding of and ability to function in a managed care environment. In addition, the newsletter provides information on current studies and showcases model health care delivery and practice programs for replication.
The latest issue of the newsletter available online is the June 2001 issue.
The Center's Fact Sheet provides basic information about the Center for Health Services Financing and Managed Care.
IOM Study: Impact of Medicaid Managed Care on Safety-Net Providers
HRSA funded the Institute of Medicine (IOM) to examine the effects of Medicaid managed care and the managed care environment on the viability and future integrity of safety-net providers in primary health care settings. The identified health service providers included but were not limited to: community health centers, maternal and child health centers, Ryan White HIV/AIDS program and rural health centers. The IOM Study Committee consisted of nationally recognized providers, researchers and policy analysts working on safety net issues.
The Center for Health Services Financing and Managed Care disseminated the findings of this important study through a variety of mechanisms including congressional briefings and internal briefings of senior Departmental and Agency officials and managers. The report was also widely distributed to HRSA grantees, those involved in the health care safety net around the country, and venues were identified for presentations of the key findings of the IOM study
To respond to the study, the Center for Health Services Financing and Managed Care is participating with the Agency for Healthcare Research and Quality (AHRQ) and the Office of the Assistant Secretary for Planning and Evaluation in a joint effort to determine the feasibility of creating a data system to improve the ability to monitor the changing structure, capacity and financial stability of the safety net. The three agencies have agreed to a three-part strategy to develop a clearer knowledge of what needs to be measured and to identify opportunities and strategies to develop data capacity and assess the feasibility of a monitoring initiative.
HRSA Press Release
Report - America's Health Care Safety Net: Intact but Endangered
Executive Summary (Adobe Acrobat format)
The National Academies WebLocal Health Department Study on Delivery of Health Care Services
The University of Pittsburgh School of Public Health is studying the changes in both urban and rural health departments related to their function as safety net providers. The study is evaluating the extent and the impact of changes due to managed care and related forces (such as welfare reform and the changing roles of health departments) on health department capacity to provide or assure personal health services to low income and vulnerable populations. The study is in its final phase with a report expected in late summer.
Safety Net Provider Capacity For Care To Low-Income Uninsured Patients
There is a growing need to understand the impact of economic and policy changes (e.g.: welfare and immigration reform) on the capacity of safety net providers to provide outpatient services to underserved low-income uninsured persons. Evidence indicates that the role of safety net providers continues to grow while under increased financial pressure due to: 1) the implementation of Medicaid managed care and 2) the continued rise in the number of uninsured and underinsured.
This study, funded by HRSA and conducted by Mathematica Policy Research (MPR), evaluates the changing capacity of the existing outpatient safety net, e.g.: health departments, public hospitals, and outpatient safety net, e.g.: health departments, public hospitals, and other community-based providers to serve low-income underserved populations, particularly the uninsured. It addresses many of the concerns raised in the IOM study: America's Health Care Safety Net: Intact But Endangered. The study includes five communities: Columbus, Ohio; Oklahoma City, Oklahoma; Kansas City, Missouri; Detroit, Michigan; and San Antonio, Texas.
The study will also identify methods of collecting information on local safety nets from both local and national sources. It is scheduled for completion by fall 2001.
Participation of School Based Health Centers in Medicaid and SCHIP
School based health centers provide primary care services in 1,300 sites across the country serving more than a million children. An invitational working conference to explore issues around participation in Medicaid and State Children's Health Insurance Programs (SCHIP) was held in Rockville, Maryland on April 23. Co-sponsors included the Center for Health Services Financing and Managed Care, the Bureau of Primary Care, and the Maternal and Child Health Bureau in HRSA along with the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration.
The meeting included approximately 85 representatives from state Medicaid agencies, state SCHIP Directors, school based health centers, managed care organizations, national association partners, and Federal agency staff from HRSA and CMS. Meeting proceedings are available on this website.
Managed Care Resource Collection in Parklawn Health Library
The Center worked collaboratively with the Parklawn Health Library in Rockville, Maryland to establish the Managed Care Resource Collection within the Library. This Resource Collection is located in the Reference Section of the Library and includes selected texts and technical reports on managed care, topical bibliographies, and a master copy of journal articles cited in the topical bibliographies. CHSFMC staff will, on an on-going basis, recommend materials for inclusion in the Resource Collection, identify needs for additional bibliographies, and create reading lists on key issues related to managed care (e.g., quality management, ethical decision making).
The Managed Care Resource Collection is available at: http://www.psc.gov/library/mancare.htm
Seminars Series on Managed Care (Brown Bag)
The Brown Bag Seminars on managed care topics are designed to disseminate information by videoconference and teleconference on current issues and best practices in the managed care field, which are particularly relevant to HRSA and Departmental programs. Please click here for a list of Managed Care Seminars.
Special Events/Conference Displays
Many players in the managed care market place are not familiar with HRSA, its programs, or the populations that HRSA serves. Conference displays offer a significant opportunity to disseminate information about HRSA's programs and activities to large segments of the managed care audience. Send requests for Center for Health Services Financing and Managed Care staff to display at conferences to FinanceMC@hrsa.gov
Send questions or comments to: FinanceMC@hrsa.gov
