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Developing a managed care delivery system in New York State for Medicaid recipients with HIV.
Am J Manag Care. 1999 Nov; 5(11):1457-65.AJ

Abstract

In the state of New York, models of care known as HIV Special Needs Plans (HIV SNPs) are being developed to meet the unique health and medical needs of Medicaid recipients with HIV. Establishing managed care plans for the 80,000 to 100,000 HIV-infected Medicaid recipients residing in the state has required considerable effort, including distributing planning grants to solicit information and recommendations regarding program and fiscal policy; convening a workgroup to facilitate discussions between the state and the provider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudinal, person-based, encounter-level database representing the clinical and service utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were capitation rates, initial capitalization levels, and risk-adjustment mechanisms. Other pertinent issues included the importance of a benefits package supporting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefits packages. From our experience in New York State, we conclude that a successful model of Medicaid managed care for persons with HIV should build on the existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communities. A future challenge lies in the implementation of the HIV SNP model and evaluation of its soundness and ability to ensure quality healthcare services.

Authors+Show Affiliations

New York State Department of Health AIDS Institute, Albany, NY 12237, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10662420

Citation

Feldman, I, et al. "Developing a Managed Care Delivery System in New York State for Medicaid Recipients With HIV." The American Journal of Managed Care, vol. 5, no. 11, 1999, pp. 1457-65.
Feldman I, Cruz H, DeLorenzo J, et al. Developing a managed care delivery system in New York State for Medicaid recipients with HIV. Am J Manag Care. 1999;5(11):1457-65.
Feldman, I., Cruz, H., DeLorenzo, J., Hidalgo, J., Plavin, H., & Whitaker, J. (1999). Developing a managed care delivery system in New York State for Medicaid recipients with HIV. The American Journal of Managed Care, 5(11), 1457-65.
Feldman I, et al. Developing a Managed Care Delivery System in New York State for Medicaid Recipients With HIV. Am J Manag Care. 1999;5(11):1457-65. PubMed PMID: 10662420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Developing a managed care delivery system in New York State for Medicaid recipients with HIV. AU - Feldman,I, AU - Cruz,H, AU - DeLorenzo,J, AU - Hidalgo,J, AU - Plavin,H, AU - Whitaker,J, PY - 2000/2/8/pubmed PY - 2000/2/8/medline PY - 2000/2/8/entrez SP - 1457 EP - 65 JF - The American journal of managed care JO - Am J Manag Care VL - 5 IS - 11 N2 - In the state of New York, models of care known as HIV Special Needs Plans (HIV SNPs) are being developed to meet the unique health and medical needs of Medicaid recipients with HIV. Establishing managed care plans for the 80,000 to 100,000 HIV-infected Medicaid recipients residing in the state has required considerable effort, including distributing planning grants to solicit information and recommendations regarding program and fiscal policy; convening a workgroup to facilitate discussions between the state and the provider and consumer communities; conducting a longitudinal survey to assess the impact of managed care on persons with HIV; and developing a longitudinal, person-based, encounter-level database representing the clinical and service utilization histories of more than 100,000 patients for state fiscal years 1990 to 1996. The key fiscal issues identified and discussed were capitation rates, initial capitalization levels, and risk-adjustment mechanisms. Other pertinent issues included the importance of a benefits package supporting a comprehensive, integrated continuum of state-of-the-art services; marketing and enrollment; attention to provider and consumer training and education needs; and interdependence of financial reimbursement and benefits packages. From our experience in New York State, we conclude that a successful model of Medicaid managed care for persons with HIV should build on the existing infrastructure of services, using a collaborative process among government agencies, healthcare providers, and HIV/AIDS consumer communities. A future challenge lies in the implementation of the HIV SNP model and evaluation of its soundness and ability to ensure quality healthcare services. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/10662420/Developing_a_managed_care_delivery_system_in_New_York_State_for_Medicaid_recipients_with_HIV_ L2 - https://www.ajmc.com/pubMed.php?pii=1131 DB - PRIME DP - Unbound Medicine ER -