Guidelines to Teaching Managed Care

Healthcare Concepts of Memphis, TN, has created this outline for holding inservices on managed care:

Session I. From Medicare to Managed Care and Beyond

1. Overview of history of managed care

2. Current managed care organizations in your area

3. MCOs your agency works with

4. Differences between entitlement programs and MCOs

5. Impact on:

• Importance of team work (both within agency and among agency and others)

• How we get paid and why we don’t

• Information we must provide and why

• Patient care and quality outcomes

6. Role of each employee (be specific for their job roles)

7. What we can expect over the next 1-3 years

Session II. Developing Customer Service Mentality

1. Who are our customers?

2. Who will be the judge of quality in the future?

3. How does this fit with our corporate mission?

4. What is the role of performance improvement?

5. How do we develop and maintain a focus on customer service?

6. What is the role of each employee? (Be very specific)

Ongoing Sessions Building Partnerships

1. Hold regular meetings among managed care case managers and home health agency clinical and operational staff to identify mutual goals, to find better ways to work together, to prevent problems.

2. Alternate sites for meetings between the MCO and the agency.

3. Periodically include referring physicians/ physician office staff.