Written for health care executives, physicians, nurses, policymakers, health services researchers, and scholars, Remaking Medicaid offers a vision of the future to which conscientious policymakers and provider organizations, working together, can aspire.

A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.

Leading Medicaid Managed Care Plans examines leadership actions necessary to successfully operate a Medicaid managed care plan with emphasis on the relationship with the state Medicaid agency the health plan is contracted with. With appropriate operational and governance oversight, and with solid mutually respectful relationships with the state agency, Medicaid health plans are more likely to sustain success and prosperity for the long term. The approach of Leading Medicaid Managed Care Plans builds on key infrastructure elements that need to be in place when contracting with a state agency, and for overall success of the organization. It takes a pragmatic and methodical approach, interspersed with real-life examples of what to do for success and what actions to avoid that frequently lead to failure. This approach is different from most managed care books (Medicaid or otherwise) as those mostly focus on the process of the business (such as details around claims payment, or provider contracting) and ignore the role of the state Medicaid agency and its importance in retaining the contractual relationship. This book differs also on its emphasis on organizational foundational elements and strategic leadership skills necessary to sustain success. The author has years of experience in turning around failing Medicaid managed care plans and observing what they all had in common that contributed to those failures. One common feature was the deterioration of the relationship with the state Medicaid agency they were contracted with, and how close they all came to losing their multi-million dollar businesses. The purpose of this book is to educate and inspire managed care executives and senior leaders who operate Medicaid health plans and to help them understand what elements are needed for successful health plans and a sustainable relationship with the people directing the state Medicaid agency.

Over the first decade of the 21st century, the role of risk-based managed health care for publicly insured beneficiaries has expanded substantially. This report examines this form of health care delivery in 20 states for both Medicaid and CHIP nonelderly adults and children, including people with disabilities. The 20 states were chosen because they include over 80 percent of both Medicaid and CHIP beneficiaries who are enrolled in risk-based managed care. Findings are based on interviews with state Medicaid and CHIP officials, as well as representatives from 40 Managed Care Organizations (MCOs) serving Medicaid and CHIP beneficiaries, and 40 health care providers or provider organizations. In addition, the report contains published data from various sources, including measures of access to care, quality of care, and satisfaction with care over the study period (2001–2010).This review of Medicaid and CHIP risk-based managed care over the first decade of the 21st century shows that well-established programs exist in 19 of the 20 study states (Connecticut being the exception) and that most states are seeking to expand their programs to cover more and higher-cost enrollees. While there is substantial variation across states in approaches, all the study states have developed ways to regularly select plans, define network requirements, and monitor access and quality. In contrast to the early years of development of Medicaid managed care, there is substantial stability in the number and types of plans participating in risk-based managed care. HEDIS and CAHPS data also suggest that preventive care use has improved under risk-based managed care and that beneficiaries are generally satisfied with their health plans. Thus, the risk-based managed care programs that currently exist provide a structure to absorb the newly covered adults under the Affordable Care Act and provide a learning laboratory and important lessons for other states in how to develop an effective risk-based managed care program for Medicaid and CHIP beneficiaries.