Silow-Carroll Sharon, Rodin Diana
Health Management Associates, USA.
Issue Brief (Commonw Fund). 2013 Apr;19:1-17.
Some managed care organizations (MCOs) serving Medicaid beneficiaries are actively engaging in community partnerships to meet the needs of vulnerable members and nonmembers. We found that the history, leadership, and other internal factors of four such MCOs primarily drive that focus. However, external factors such as state Medicaid policies and competition or collaboration among MCOs also play a role. The specific strategies of these MCOs vary but share common goals: (1) improve care coordination, access, and delivery; (2) strengthen the community and safety-net infrastructure; and (3) prevent illness and reduce disparities. The MCOs use data to identify gaps in care, seek community input in designing interventions, and commit resources to engage community organizations. State Medicaid programs can promote such work by establishing goals, priorities, and guidelines; providing data analysis and technical assistance to evaluate local needs and community engagement efforts; and convening stakeholders to collaborate and share best practices.
一些为医疗补助受益人群提供服务的管理式医疗组织(MCO)正积极开展社区合作,以满足弱势成员及非成员的需求。我们发现,四个此类MCO的历史、领导能力及其他内部因素是促成这一重点工作的主要驱动力。不过,诸如州医疗补助政策以及MCO之间的竞争或合作等外部因素也发挥了作用。这些MCO的具体策略各有不同,但有着共同目标:(1)改善医疗协调、可及性与服务提供;(2)加强社区及安全网基础设施;(3)预防疾病并减少差距。这些MCO利用数据来识别医疗缺口,在设计干预措施时征求社区意见,并投入资源与社区组织合作。州医疗补助计划可通过设定目标、确定优先事项及制定指导方针;提供数据分析及技术援助以评估当地需求和社区参与工作;召集利益相关者进行合作并分享最佳实践等方式来推动此类工作。