Successful Medicaid managed care organizations: it is not an oxymoron

Manag Care Q. 2001 Spring;9(2):5-11.

Abstract

Success as a Medicaid health plan is achieved by those plans with a clear understanding of Medicaid program requirements. Executives of Medicaid health plans identify four common elements that result in winning plans: (1) Leadership must have significant experience with, or otherwise develop knowledge of, the Medicaid program's regulations and populations covered; (2) the plan must have an internal managed care culture and system that integrates finance, operations, and medical management; (3) management must have access to highly specialized information and data analysis capability; (4) leadership must have well-developed relationships with key stakeholders. While these elements seem intuitive, health plans often enter the marketplace without needed groundwork firmly in place.

MeSH terms

  • Database Management Systems
  • Humans
  • Interinstitutional Relations
  • Leadership
  • Managed Care Programs / organization & administration*
  • Medicaid / organization & administration*
  • Organizational Culture
  • State Health Plans / organization & administration*
  • Systems Integration
  • United States