Reproductive health practices of HMOs serving urban low-income women

As managed competition expands, many health plans wish to open their membership to those on Medicaid, mostly women and children. This study examines the reproductive services of 10 diverse managed care organizations historically targeting large numbers of poor women for care through prepaid Medicaid contracts. These institutions think themselves united and unique within managed care because of their long-term commitment to serving patients on Medicaid. Although the interviews with providers and administrators explore many aspects of reproductive care, most of these health maintenance organizations (HMOs), by the nature of their funding and federal mandates, have more aggressive and defined programs for pregnant women and for infants. These urban-based providers have discovered by trial and error the challenges of getting quality health care to poor women: external administrative or bureaucratic challenges because of Medicaid, internal administrative or provider barriers, and the artifacts of patient behavior. Strategies to address these problems involve attending to political and bureaucratic factors affecting care, taking a broader social view of patients and their community, using community resources to supplement HMO benefits, maximizing each contact with patients with multiple interventions, case management to monitor underutilization, aggressive outreach, service, and follow-up.