The Nebraska Center for Rural Health Research

Managed Care for Rural Elders:
Can It Work?

February 25, 1999

Author: Keith J. Mueller, Ph.D.

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Table of Contents:

Managed Care for Rural Elders: Can It Work?

YES, IT CAN; IF ONLY ......

Rural Providers are Ready Rural Health Plans are Ready Payment is Appropriate Beneficiaries are Ready

What Has Happened to Date?

Changes in Payment

Changes in Payment (cont.)

Changes in Enrollment Through September, 1998

Source: Rural Policy Research Institute (RUPRI) Health Panel

HMOs Pulling Out

What Does It All Mean?

Are Provider Sponsored Organizations the Approach for Rural Managed Care?

Are the Regulations Overwhelming?

But Then There Is the Alternative .....

But Then There Is the Alternative ..… (cont.)

To Summarize

To Summarize (cont.)

Blending in Public Program Initiatives

So What is Next?

Deciding to Develop Rural Managed Care Products Questions to Ask

If Yes, Then Analyze

Among the Rural Providers and Supporters, Is There Capacity for:

Building Blocks for Success in Managed Care

Financial Issues

Financial Issues (cont.)

Organization Design

Organization Design (cont.)

Plan Design

Plan Design (cont.)

Plan Design (cont.)

Quality Assurance

Marketing

Marketing (cont.)

Negotiations

Role for State Government

Nebraska Center for Rural Health Research