A Managed Care Model for Latino Adults With Chronic Illness and Disability

Abstract

The authors evaluated a managed care model developed for use by community-based providers to improve health care outcomes for low-income Latinos with disabilities and chronic illnesses. Through this model, Medicaid enrollees with special health care needs were identified and received enhanced primary care, on-site mental health and addiction services, care coordination, and support services based on their levels of need. The goal of the demonstration was to determine whether capitation would be a catalyst to transform typical primary care delivery processes to provide enhanced, culturally competent care to patients with complex health care and psychosocial needs. Despite a significant investment in outpatient services, the intervention was cost effective due to a dramatic decline in inpatient care for a few enrollees. For most enrollees, care was slightly more expensive due to enhanced outpatient medical and mental health care. Enrollees expressed high satisfaction with the intervention.

Barriers to Health Care Among People With Disabilities Who are Members of Underserved Racial/Ethnic Groups

“…In addition to language (3 studies), 37,38,40 barriers were: patient mistrust of the medical establishment by African Americans (2 studies) 42,46 ; low acculturation (1 study) 47 ; and problems with physician-patient communication (1 study). In addition to language (3 studies), 37,38,40 barriers were: patient mistrust of the medical establishment by African Americans (2 studies) 42,46 ; low acculturation (1 study) 47 ; and problems with physician-patient communication (1 study).…”

“…[37][38][39][40][41][44][45][46][47] In all 9 cases, at least one of these factors was found to be a barrier to health care access. Nine of the 10 studies examined at least one of these factors.…”

India's Aspirations for Universal Health Coverage

“…Traditional insurance type mechanisms (as opposed to Managed Care) are not well suited to purchasing and managing this h The HLEG's discussions with insurance companies participating in RSBY suggest that this is already starting to happen in states such as Kerala where utilisation levels are rapidly moving upwards. i For example, Bachman et al (2008) 13 evaluate "a managed care model developed for use by community-based providers to improve health care outcomes for low-income Latinos with disabilities and chronic illnesses. Through this model, Medicaid enrolees with special health care needs were identified and received enhanced primary care, on-site mental health and addiction services, care coordination, and support services based on their levels of need.…”