Open AccessViewpoint on Medicaid managed care and public health data
Author(s) -
Rutherford Gw,
Backer Hd
Publication year - 1999
Publication title -
public health reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.202
H-Index - 92
eISSN - 1468-2877
pISSN - 0033-3549
DOI - 10.1093/phr/114.3.225
Subject(s) - medicaid , managed care , medicaid managed care , leverage (statistics) , business , health care , public health , agency (philosophy) , population , psychological intervention , environmental health , medicine , nursing , computer science , economics , philosophy , epistemology , machine learning , economic growth
In summary, there are a number of ways in which state public health data can be of value in the design of Medicaid managed care plans. At the level of the purchaser, such as a state Medicaid agency, public health data can assist in decision-making around pricing policy and can be useful in prioritizing interventions for those conditions that most severely affect the covered population. Quality assurance standards such as the HEDIS clinical performance measures can be used to define a baseline of prevention-oriented services or, by adding additional customized data points, to emphasize a particular service. From the standpoint of the managed care plan, public health data can be useful in understanding the needs of a community it serves or would like to serve and in estimating the prevalence of various conditions in that community that will influence the premium it will charge. Thus, there are multiple routes through which public health goals and priorities can be incorporated into managed care and can leverage the power of managed care to improve the public's health.