Managed Care, Medicaid, and Public Health: Building Collaborations That Work

Crafting Policies

Presenters: Robert Fulton, M.Ed., Director, St. Paul-Ramsey County Department of Public Health, St. Paul, MN. Carol Berg, R.N., M.P.H., Community and Public Health Manager, UCare Minnesota, Minneapolis, MN. Donna Zimmerman, M.P.H., Director of Government Programs, HealthPartners, Bloomington, MN.

Panelists stressed that managed care organization (MCO) collaborations with public health departments make sense from an industry standpoint, using population-based strategies to control spiraling costs. In trying to ensure that participating in a specific collaboration makes business sense, one MCO developed the following considerations:

• Does the opportunity have the potential for achieving improvement in the health of the community?
• Would the opportunity meet one of the community's high-priority health goals?
• Does the opportunity support the MCO's business objectives (e.g., diabetes management)?
• What is the potential impact on key relationships that the MCO wants to develop and maintain (e.g., State and/or local governments, large employers, key provider groups)?

In Minnesota, regulated collaborations are created through:

• Collaboration plans, submitted annually by MCOs to the State Department of Health after being developed jointly with local public health departments, describe actions taken/to be taken to achieve public health goals.
• Action plans (also submitted biennially), in which MCOs describe to the State how they will meet the needs of certain populations (e.g., people for whom English is a second language).
• Contracts with essential community providers (designated by the State).
• Public health goals articulated in the Medicaid managed care contracts.

The benefits of regulated collaboration include: getting everyone to the table, defining MCO accountability, and leveling the playing field. Limitations include: it is more difficult to reach agreement on specific language because contract enforcement is involved and resources will be directed to mandatory—rather than voluntary—collaborations, and activities may be limited to a special population or group.

Voluntary collaborative efforts are also happening through such groups as the Minnesota Council of Health Plans' Community Health Committee (a forum for MCOs to plan joint activities), the Minnesota Health Improvement Partnership (a statewide advisory body for the State's Department of Health), and regional and local groups (such as the Local Public Health Association of the Metropolitan Area).

One regional group is the Center for Population Health, which has partners from both public and private sectors, including local health departments, MCOs, and hospitals. Started in 1995, the center's executive committee and issue-specific task forces work on initiatives related to hepatitis B prevention among adolescents, bike helmet promotion, policy development and monitoring, an immunization registry, violence prevention and response, and data. The Center annually evaluates its value to the participants in order to make sure it continues to meet their needs and thereby sustain its effectiveness.

Barriers that need to be overcome for a successful collaboration include:

• Getting the right people to the table.
• Having consistency in the people at the table.
• Finding the time for working together.
• Dealing with differences between the collaboration's goals and individual organizations' goals.
• Finding common language.
• Governing the collaboration and dealing with political and funding issues.
• Finding resources and determining how to share them.
• Handling competition and "who gets the credit."
• Figuring out how to include purchasers (particularly large employers) at the table.
• Getting buy-in to multidisciplinary, multi-organizational efforts.

Lessons learned include:

• Know yourself and your mission.
• Know your community and the potential players for a collaboration.
• Be at the planning and implementation table, even if you have to fight your way in.
• Recognize opportunities and limitations with infrastructure and mandated collaborations.
• Understand that developing relationships takes time.
• Realize that MCOs will be more interested in participating if the collaboration focuses on areas in which they have member market share and on issues in which they have made other investments.
• Choose projects with broad-based support.
• Consider partnerships beyond "funding." Realize that many initiatives do not rely so much on "big money" but rather on "big time" from the partners.
• Understand that competition can be both useful and a barrier to success.
• Remember the importance of quantifying and giving credit for in-kind donations (e.g., physician time).

Finally, essential steps in selecting public health goals for collaboration include:

• Review the local community health plans and State public health goals.
• Review the public health goals of each MCO as stated in their collaborative plan.
• Identify common areas of interest.
• Develop strategies and roles for each participant.
• Assess capacity and readiness of all participants.
• Develop monitoring and evaluation criteria.

References

Background. Center for Population Health;1995 Dec.

Draft for discussion: year 2000 public health goals PMAP contract. Minneapolis(MN): Health Plans and Public Health Departments;1999 Apr.

Draft workplan: public health goals and EPMAP contract language. Minneapolis(MN): Metropolitan Local Public Health Association;1998 Aug.

EPSDT workplan. St. Paul(MN): Minnesota Council of Health Plan;1999 Oct.

Health plan roles in supporting essential public health service functions. St. Paul(MN): Minnesota Council of Health Plans;1998 Apr.

Southeast (11 county) domestic violence project. Minneapolis(MN): Minnesota Department of Health;1998.

General information. Minneapolis(MN): Minnesota Health Improvement Partnership;1999.

State of Minnesota. Collaborative plans and public health goals: legislative statutes (1997) Chap. 2, Art. 4.

State of Minnesota. Minnesota laws: collaborative plan legislation (1996): Chap. 451, Art. 4, Sec. 3.

Steps for addressing local public health goals through medical assistance purchasing contracts: guidance for counties. Minneapolis(MN): State Community Health Services Advisory Committee;1998 Jan.

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