Performance Improvement 1999. Health Care Delivery

02/01/1999

TITLE: Roundtable Report: Integrating Indian Health Programs Into Medicaid Managed Care Systems

ABSTRACT: This project was convened to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by the Indian Health Service (IHS), programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act. The overall goal of the roundtable was to determine how to increase participation in Medicaid managed care among Indian health programs while maintaining organizational mission and capacity to provide a comprehensive and culturally sensitive health care system for American Indians and Alaska Natives (AI/Ans). Roundtable participants expressed their beliefs that the IHS must facilitate increasing the participation of Indian health programs in Medicaid managed care in conjunction with the tribes and the urban Indian programs. The Roundtable's recommendations were as follows: (1) discuss and resolve the five issue areas that include: risk adjustments, contracting only for those services that the Indian health program directly provides, taking risk only for the amount the program can afford to lose; off-loading risk; and managing care; (2) inclusion of managed care in all IHS strategic planning; (3) being proactive in discussions with the individual States; and (4) further follow-up work on the development of Indian health programs as Health Maintenance Organizations or networks.

AGENCY SPONSOR: Office of Public Health, Staff Office of Planning, Evaluation and Research

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7136

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD
 

TITLE: The Data Policy Roundtable: Exploring the Future of Indian Health Information Systems

ABSTRACT: This project was convened to explore options and develop strategies for future Indian Health Service/Tribal/Urban (I/T/U) program information systems. The focus was on developing strategies to create a new Indian Health information system, one that was not an Indian Health Service (IHS) system, but rather a system designed and supported by the Tribal and Urban health care delivery organizations and the IHS. Roundtable participants represented Tribal and Urban programs, national and regional Tribal Health Boards, IHS statistical, epidemiological and information system divisions, the nursing and clinical professions, and industry experts in new technologies. Recommendations included the following: (1) establish an I/T/U Program Data Consortium; (2) develop a uniform data set; (3) determine a means for aggregating the data; (4) determine how best to account for non-participating I/T/U entities in the presentation of national aggregate data; (5) adopt, along with the data set, data content and transmission standards to ensure that aggregate data are comparable and can be transmitted between systems, independent of hardware and software configurations; (6) develop a means for maintaining and upgrading the Resource and Patient Management System and the Patient Care Component to meet the needs of the I/T/U participants who choose to continue to use it; (7) make greater use of current and new information and communication technologies to improve the Indian health program; (8) establish a clearinghouse to share information models related to specific health problems and conditions; (9) develop an I/T/U finance committee or commission to address funding issues; and (10) establish an environment that fosters an equal partnership among I/T/Us.

AGENCY SPONSOR: Office of Public Health, Staff Office of Planning, Evaluation and Research

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7135

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD