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Pediatric system uses contracts with providers, plans to shape its role in managed Medicaid
Public Sector Contracting Report : the Monthly Guide to Medicare and Medicaid Managed Care
|June 3, 1999
Insights
Cook Children's Health Care System achieved control over managed Medicaid by establishing its own provider network and unique contracts. This strategy successfully reduced healthcare utilization and resulted in physician bonuses under full-risk agreements.
Area of Science:
- Healthcare Management
- Pediatric Health Systems
- Managed Care Economics
Background:
- Pediatric provider systems face challenges in managing Medicaid populations.
- Managed care models require innovative approaches for effective cost and utilization control.
Purpose of the Study:
- To examine how a pediatric health system gained control within managed Medicaid.
- To analyze the strategies employed to lower utilization and manage financial risk.
Main Methods:
- Case study of Cook Children's Health Care System in Fort Worth, TX.
- Development of an in-house provider network.
- Implementation of unique contracting arrangements with Medicaid plans.
- Analysis of full-risk contract performance.
Main Results:
- Reduced healthcare utilization within the managed Medicaid population.
- Successful implementation of full-risk contracts.
- Distribution of physician bonuses based on performance.
Conclusions:
- Establishing a dedicated provider network and innovative contracts can enhance control in managed Medicaid.
- Full-risk contracting can align provider incentives with system goals for utilization and cost management.
- This model demonstrates a successful strategy for pediatric health systems operating in managed care environments.
Abstract
Case Study:
A pediatric provider system seeks control in managed Medicaid. By creating its own provider network, and making some unusual contracting arrangements, Cook Children's Health Care System in Fort Worth, TX, has lowered utilization and even paid bonuses to physicians under its first full-risk contracts with three Medicaid plans. See how this system's providers set themselves up to succeed.