US "Best Practice" In Managed Care

To improve managed care options and policies for Medicare and Medicaid beneficiaries, the Office of Managed Care at the US Health Care Financing Administration has conducted a study to identify some "best practices" of managed care organizations. It developed a model MCO which clustered activities into organizational and managerial, clinical and administrative activities, in which MCOs reported their best practices.

From this, the HCFA says it is particularly concerned about how MCOs plan to provide for the special needs of the very elderly, indigent and disabled, ie in planning and coordination of clinical and support services, health screenings and assessments, and outcomes measurement. For example, one MCO details a program to maintain seniors in their own homes as long as possible through care management and community-based services, providing substantial health education and prevention-oriented services. Using more long-term care services was found to use fewer high-cost services, and the program is conserving state funds. Without it, around 750 elderly people would go to nursing homes, with half of those in state-paid nursing homes, the study reported.