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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
- 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.
- 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
- 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.
- 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.
II. MANAGED CARE TECHNICAL ASSISTANCE |
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:
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.
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