A. Subject Areas for Managed Care Training Sessions

Currently Available Managed Care Training Sessions

The Bureau of Primary Health Care (BPHC) has developed a managed care training program in cooperation with the National Association of Community Health Centers (NACHC).

Please note that every effort will be made to tailor the training programs to meet local needs. This will be accomplished by having faculty contact (by phone and in writing) those requesting the training prior to the session to identify specific problem areas which grantees wish the trainers to address.

The training program includes each of the following training sessions:

• Management Information Systems (MIS) Changes for Managed Care - New this fiscal year, this 1-day session focuses on the changes required in health center MIS as a result of participation in managed care activities. Included are critical performance measures, assessment of system capacity, data collection and reporting, and an interactive case study to enhance the learning experience. The target audience includes executive directors, clinical directors, fiscal managers, MIS managers and board members.
• Developing and Operating Networks - New this fiscal year, this 1-day session addresses how to develop and operate managed care networks. It includes (1) how to develop the provider delivery system; (2) key principles in provider contracting; (3) how to determine capitalization requirements and sources of capital; and (4) key operating requirements for network effectiveness. It also addresses insurance licensing issues and principles for utilizing a management service organization (MSO).
• Advanced Contract Negotiations (Part II) - This 1-day session addresses legal aspects of negotiating a contract with a managed care plan, including liability issues, specificity and scope of services and related responsibilities.
• Medical Management - New Clinical Responsibilities and Quality Assurance This 1-day session provides information on the role of the primary care physician and clinical staff in managed care, including the components of a utilization management program, prior authorization, control of emergency room use, and referral procedures. The session also provides information on the elements necessary for a quality assurance system related to managed care, including an overview of managed care industry standards. The target audience for the session includes, but is not limited to clinical directors, clinical staff members, executive directors and financial directors.
• Fiscal Implications of Managed Care - This 2-day session provides the participants with useful tools on how to assess the costs associated with primary care services, create appropriate risk arrangements, connect costs to a capitation rate, and assess the adequacy of capitation rates. The target audience includes, but is not limited to financial staff members, executive directors and clinical directors.
• Negotiating a Managed Care Contract (Part I) - This 1-day session provides the skills and tools required to effectively negotiate a contract with a managed care plan and to manage the relationship with the managed care plan for the benefit of both parties. This session also provides specific information on how to evaluate a managed care plan's, proposal, and the key terms and elements of a managed care contract. The target audience includes, but is not limited to executive directors, clinical directors and financial directors.
• Marketing - This 1-day session examines the components and strategies involved in a successful marketing campaign. As the competition for patients increases, Federally Qualified Health Centers (FQHCs) must understand market share, the best strategy for the community, how to target the right individuals, and conduct analyses that will yield the most useful data, and how to interface effectively with the State Medicaid Agency. The target audience includes, but is not limited to executive directors, financial directors and marketing managers.
• Planning for Network Development - This 1-day session establishes a framework and explores options for health center networks in a managed care environment. This session provides an analysis of the organizational design of networks covering mission/value implications, clinical implications, business and managerial implications, financial considerations, legal assessment and impact analysis.
• Community-Based Boards in Managed Care Environment - This half-day introductory session for health center boards covers the basics of managed care, defines terms, explores concepts and changing incentives, financing delivery system and legal considerations. Managed care policy and marketplace trends are presented along with an analysis of implications for health centers.
• Capital Development - This half-day session addresses the ever pressing health center need for capital, both for facilities and assumption of risk in a competitive managed care environment. Various approaches to capital development and use of capital are presented along with an analysis of the considerations in the various approaches. This session can be enhanced based upon individual State Primary Care Association request to include a presentation by the National Coop Bank, the State health financing authority (if there is one) and successful local health center capital projects.
• Basics of Managed Care - This 1-day session focuses on the basic principles of managed care and the implications for FQHCs.
• The Impact of Managed Care on the Homeless and Migrant Populations and Providers - This 1-day session is designed to provide Health Care for the Homeless (HCH) and Migrant providers with a basic understanding of managed care including capitation development, risk assumption, utilization review and quality assurance. The program will also focus on the unique issues of HCH and migrant providers participating in a managed care system and the impact on the organization and migrants and homeless people. Participants will gain knowledge on the strategies to survive in a managed care environment including networking with other providers and negotiating contracts with managed care companies.

B. Managed Care Training Target Audience

The managed care training program has been developed for Community Health Centers, Migrant Health Centers, Health Care for the Homeless, Centers for Residents of Public Housing, ISNs, FQHC-look alikes, Ryan White Title IIIb Early Intervention Organizations, Cooperative Agreement contacts and State/Regional Primary Care Associations (S/RPCAs). To the extent that space is available, other essential community providers (e.g., maternal and child health providers, National Health Service Corps sites, family planning providers, organizations providing mental health and substance abuse treatment services) should attend the training sessions.

Invitees should also include staff members from the Public Health Service (PHS) Regional Office (RO). In addition, the State Medicaid Agency and the Health Care Financing Administration (HCFA) RO may also be invited to the training session.

C. Managed Care Training Program Faculty

The managed care training sessions include faculty members who are experts in managed care issues. The majority of the faculty hold or have held senior executive positions in managed care organizations and bring essential managed care experience to the training sessions.

D. Planning the Sessions

It is expected that information regarding anticipated training needs is shared between the S/RPCA and the PHS RO, particularly at the beginning of each fiscal year. The sharing of managed care training plans and expectations will facilitate the implementation of training programs.

E. Requesting Managed Care Training Sessions

1. Who Can Request Managed Care Training Sessions

   The Bureau encourages all training sessions to be scheduled by the S/RPCA or by a group of Bureau-supported programs (such as an ISN). This will promote the dissemination of training information to multiple organizations and will further the ability of organizations to improve network formation in a locality and avoid duplication of efforts. Section 3.b. below details the procedures to be followed. A group of Bureau-supported service delivery programs should notify the S/RPCA that they have requested the training.

2. How to Request Managed Care Training Sessions

State/Regional Primary Care Associations (on behalf of their members), or a group of Bureau-supported service delivery programs, may schedule training by calling or writing to:

Yvonne Bice
National Association of Community Health
Centers Suite 122 1330 New Hampshire Avenue, N.W.
Washington, DC 20036
Tel: 202/659-8008

It is also permissible to address requests directly to the Bureau of Primary Health Care by calling or writing to:

Rhoda Abrams or Beth Tutunjian
Bureau of Primary Health Care
Office of Program and Policy Development (OPPD)
4350 East-West Highway Bethesda, MD 20814
Tel: 301/594-4060
Fax: 301/594-4984

3. Site Specific Tailoring of Training Sessions

   Site specific tailoring of training sessions will be accomplished by having faculty contact (by phone and in writing) those requesting the training prior to the session to identify specific problem areas which grantees wish the trainers to address.
   

4. Tasks for Requestor of Managed Care Training Sessions

a. Conference Logistics

The requesting organization or group is expected to arrange the following:

• selection and arranging of a location;
• registration information;
• making training curriculum and evaluation forms available to participants;
• inviting all participants, including all Bureau-funded grantees, staff members from the PHS, other community providers (where possible) and if considered appropriate, staff from the State Medicaid Agency and HCFA Regional Offices.
• assure that attendees complete evaluation forms of the session and forward forms to the BPHC and to NACHC at contacts listed in #E2 above.

b. Submission of a Request for Training Faculty

The requesting organization or group is expected to submit a request to the PHS RO for assignment of training faculty immediately after the initial scheduling of a training session:

• Include in the request if known, the names of the faculty along with the proposed dates of the training session.
• Requests must be received by the PHS RO in a prompt manner in order to allow sufficient time for the PHS RO to submit the Standard TA Request Form to OPPD.
• Within 48 hours, the request will be acted upon by OPPD and appropriate trainers will be selected for the managed care training session.

A. Subject Areas for Managed Care Technical Assistance Technical assistance (TA) can be sought in any area associated with managed care, including but not limited to the following:

• Network Feasibility - Assistance in the early stages of network development, including assessment of FQHC readiness for managed care, how to do a feasibility study and strategic business planning.
• Network development and operations - This area includes the range of managed carerelated activities from requirements for obtaining an insurance license to the development of a business plan, the development of the delivery system, contracting and payment to providers, and managing integration.
• Contract review and negotiations - As stated in previous Bureau communications, grantees should submit managed care contracts for review and comment. The contract will be reviewed by a managed care expert and a report will be developed for the grantees that addresses an assessment of risk arrangements, the adequacy of the capitation rate and other related factors. The review will help grantees in negotiations with managed care plans or with State Medicaid agencies. Grantees may request both a review and Assistance in negotiations. The review is not an approval of the content of the contract and is offered as a service to grantees.
• Rate setting, capitation and risk management - assistance in assessing the adequacy of capitation rates and risk arrangements for both individual plans and networks.
• Clinical management, utilization review and quality management - assistance in the improvement of clinical capacity and clinical systems to meet the needs of a managed care system, including an assessment of appointment scheduling systems, 24-hour on-call procedures, emergency room utilization, billing practices, and approaches to recruitment and retention as they relate to managed care programs. Assistance is also available in reviewing common health maintenance organization provider requirements concerning covered services, prior authorization procedures, referrals and other utilization review.
• Marketing, enrollment, patient education how to retain and expand patient base through marketing and patient education; and
• Management information systems (MIS) support in defining the necessary elements of an MIS for managed care.
• Other - any other areas of concern to grantees related to managed care operations.

B. Target Audience for Technical Assistance

Technical assistance is available to all Bureausupported service delivery programs. We encourage, where possible, that programs work together to request TA as a group or as a Bureau-supported service delivery program working with other community-based providers. This will allow more Bureau-supported service delivery programs access to limited TA resources.

C. Technical Assistance Consultants

Technical assistance is provided by consultants who are managed care experts. Many of the consultants are experienced senior level managers in the managed care industry and community health center personnel with significant managed care experience. Technical assistance may be provided on-site (e.g., strategic planning) or TA may be provided off-site through correspondence (e.g., assessing prepaid contracts). In both cases, TA requests are being fulfilled on behalf of the grantee and the grantee is the client.

D. Requesting Managed Care Technical Assistance

Regional Office:

• Individual or groups of Bureau-funded or Bureau-supported service delivery programs, S/RPCAs (on behalf of their members), should request TA by calling or writing to their RO project officer. While this is the preferred approach, it is also permissible to request TA directly from the Bureau by calling or writing to:

  Rhoda Abrams or Beth Tutunjian
  Bureau of Primary Health Care
  Office of Program and Policy Development (OPPD)
  4350 East-West Highway Bethesda, MD 20814
  Tel: 301/594-4060
  Fax: 301/594-4984

• The TA request will be assessed as soon as it is received in the PHS RO or in the OPPD. The OPPD will notify and discuss direct requests for TA with the RO.

Requests received in the PHS RO will be forwarded to the DCMH and shared with OPPD. All TA requests will be acted on within 36 hours of receipt in the DCMH or OPPD.

• A staff person from the RO, OPPD or a contractor will follow up with the requesting organization to clarify any question and/or to inform them of the assigned consultant. In most cases, the consultant will also contact the requesting organization directly.
• Reports on the TA provided will be submitted directly to the requesting organization.
• The requesting organization is encouraged to report to the contractor or OPPD on the quality and usefulness of the TA.