Managed Care in the Inner City: The Uncertain Promise for Providers, Plans, and Communities / Edition 1

by Dennis P. Andrulis, Betsy Carrier

Overview

Managed Care in the Inner City presents a well-documented and candid look at how the managed care revolution has affected low-income and other vulnerable populations who live in inner cities. This groundbreaking book offers a thorough review of the drastic changes to the way health care is delivered in America's cities and presents sensible recommendations for creating programs that will satisfy public health agendas and also succeed from a policy and health care management perspective.

Product Details

ISBN-13:	9780787946234
Publisher:	Wiley
Publication date:	05/12/1999
Pages:	224
Product dimensions:	6.32(w) x 9.41(h) x 0.81(d)

About the Author

DENNIS P. ANDRULIS is director of the Office of Urban Populationsat the New York Academy of Medicine. He is a contributing editor tothe American Journal of Medicine and a founding board member of theAmerican International Health Alliance, which creates health carepartnerships with U.S. and Central and Eastern European providersof health care. He has published extensively on a broad range ofhealth policy issues. Andrulis is former president and CEO of theNational Public Health and Hospital Institute. BETSY CARRIER isvice president for managed care at the National Association ofPublic Hospitals & Health Systems and has worked in health caremanagement for over 20 years. She has extensive experience indeveloping managed care plans and case management programs forindividuals covered by both Medicaid and commercial insurance.

Table of Contents

Tables and Figures.

Preface.

Acknowledgments.

The Authors.

Chapter 1: Managed Care and the Ecology of the Inner City.

The Inner City Environment.

Access to the Health System.

Chapter 2: Managed Care, the Safety Net, and Inner CityResidents.

Managed Care Organizations: Benefits and Concerns for the InnerCity.

Managed Care Respond to Inner City Populations and Their HealthCare Needs.

Safety Net Providers, Managed Care and VulnerablePopulations.

Chapter 3: Implementing Managed Care in the Inner City.

Community Health and Public Health Issues.

Physicians and Allied Health Professionals.

The Traditional Providers of Care in the Inner City and TheirIntegration with Managed Care.

Chapter 4: Integrating Urban Teaching Hospitals into ManagedCare.

Old Questions, New Issues for Urban Teaching Hospitals and TheirMedical Schools.

Urban Teaching Hospitals and Managed Care: Results from a NationalSurvey.

Chapter 5: Financing Managed Care for Urban Populations.

Capitation Rates, Risk Adjustment, and Adverse Selection.

The Challenges of Attaining Stability in Enrollment.

The Special Circumstances of the Uninsured.

The Threat and the Opportunity for Inner City Safety Net Hospitals.

Editorial Reviews

Reviewer: Alan K. David, MD (Medical College of Wisconsin)
Description: This is a book that examines the advent of managed care as it relates to inner city/urban medicine healthcare as managed care has become a more prevalent form of managing costs in the American system. Events that have occurred in different parts of the country are described in terms of access, costs, and quality. Many appropriate questions are raised as a result of the examples in each section and chapter.
Purpose: The stated purpose is to "bring to light and discuss the dynamics around managed care and the inner city providers that could create better healthcare for these populations or could worsen an already difficult situation." In essence, the purpose is to examine the question: will managed care make things better or will it make things worse?
Audience: The target audience appears to be healthcare administrators, managed care executives, providers of healthcare, as well as certain members of the public sector who are concerned with access and quality of healthcare for relatively urban/inner city populations.
Features: This book deals with a description of the culture of the inner city environment, usual patterns of care in the past in the inner city, the concept of the safety net, issues caused by changes in healthcare funding in the inner city, the impact of managed care on urban teaching hospitals, and a limited discussion of the financing issues with regard to urban populations of patients in relationship to managed care. The overall theme seems to be one in which managed care, with greater efficiency, could make care in the inner city better or, because practitioners do not understand the culture/problems of inner city populations and are concerned with cutting costs, may make care for inner city residents much worse. An example is found on page 83 where the authors state in the conclusions section that "managed care can bring a focus on efficiency and patient satisfaction." While this is not really validated, it seems common sense. On page 84, the authors present this conclusion — "finding common ground becomes imperative if these essential missions are to thrive."
Assessment: The authors take a very difficult issue and do a good job of describing changes in healthcare and the difficulties that managed care has brought to bear on the inner city environment. This is not totally different from its impact on any other population, however. Many appropriate questions are raised but very few pragmatic or new solutions are offered. Simplistic statements are often made, particularly in the concluding chapter, which are either unfounded or simply common sense as noted in the previous paragraph. The book is excessively wordy and far more focused on questions rather than answers. The references are appropriate. Particular models for solutions or remedies do not play a major role in the final chapter entitled, "Toward an Effective Managed Care System." In essence, the book is descriptive but does not close the loop in terms of new or innovative solutions nor does it present models that have been extremely successful and could be emulated across the country.

Doody's Review Service

"Managed care is a two-edged sword for vulnerable residents of theinner city and the providers that serve them. Managed Care in theInner City provides a balanced and scholarly analysis of thepotential of managed care concepts for Medicaid patients and theuninsured. This book should be read by policymakers at the local,state, and national levels and by providers in public hospitals andcommunity health centers." (Ron J. Anderson, president and CEO,Parkland Health & Hospital System)

"If we think of managed care as representing a kind of globalwarming for indigent-care eco-systems, then our urban healthsystems are indeed among the most Andangered. This timely bookprovides us with valuable information and insight with which tounderstand the nature and extent of jeopardy urban health careproviders are facing. In addition to providing a candid andthoughtful diagnosis, the authors go much further by identifyingsome of the concrete strategies and tactics being employed forsurvival in this environment and posing some critical policyquestions that simply cannot be avoided." (Robert Hurley, associateprofessor, Medical College of Virginia)

"In this book Dennis Andrulis and Betsy Carrier examine the claimsmade on behalf of managed care and pose unsettling questions as towhether this new cure will really work or only make matters worsefor inner-city residents. The authors, who come from thepublic-hospital sector, are measured and fair in the treatment oftheir subject." (Health Affairs)

From the Publisher

2 Stars from Doody

This is a book that examines the advent of managed care as it relates to inner city/urban medicine healthcare as managed care has become a more prevalent form of managing costs in the American system. Events that have occurred in different parts of the country are described in terms of access, costs, and quality. Many appropriate questions are raised as a result of the examples in each section and chapter. The stated purpose is to ""bring to light and discuss the dynamics around managed care and the inner city providers that could create better healthcare for these populations or could worsen an already difficult situation."" In essence, the purpose is to examine the question: will managed care make things better or will it make things worse? The target audience appears to be healthcare administrators, managed care executives, providers of healthcare, as well as certain members of the public sector who are concerned with access and quality of healthcare for relatively urban/inner city populations. This book deals with a description of the culture of the inner city environment, usual patterns of care in the past in the inner city, the concept of the safety net, issues caused by changes in healthcare funding in the inner city, the impact of managed care on urban teaching hospitals, and a limited discussion of the financing issues with regard to urban populations of patients in relationship to managed care. The overall theme seems to be one in which managed care, with greater efficiency, could make care in the inner city better or, because practitioners do not understand the culture/problems of inner city populations and are concerned with cutting costs, may make care for inner cityresidents much worse. An example is found on page 83 where the authors state in the conclusions section that ""managed care can bring a focus on efficiency and patient satisfaction."" While this is not really validated, it seems common sense. On page 84, the authors present this conclusion -- ""finding common ground becomes imperative if these essential missions are to thrive."" The authors take a very difficult issue and do a good job of describing changes in healthcare and the difficulties that managed care has brought to bear on the inner city environment. This is not totally different from its impact on any other population, however. Many appropriate questions are raised but very few pragmatic or new solutions are offered. Simplistic statements are often made, particularly in the concluding chapter, which are either unfounded or simply common sense as noted in the previous paragraph. The book is excessively wordy and far more focused on questions rather than answers. The references are appropriate. Particular models for solutions or remedies do not play a major role in the final chapter entitled, ""Toward an Effective Managed Care System."" In essence, the book is descriptive but does not close the loop in terms of new or innovative solutions nor does it present models that have been extremely successful and could be emulated across the country.

Alan K. David

Examines how the managed health care revolution has affected low- income and other vulnerable populations who live in inner cities, and makes recommendations for creating programs to will satisfy public health agendas and succeed from a policy and health care management perspectives. Concludes that managed care must find ways to work with the existing networks of doctors and hospital that already understand the patients, their problems, and their lives. Annotation c. Book News, Inc., Portland, OR (booknews.com)

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