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Children with Special Healthcare Needs

Developing Provider Networks

Presenters:

Dann Milne, Ph.D., Manager of Delivery Systems Development, Colorado Department on Healthcare Policy and Financing.

Jane Finn, Director, Children with Special Health Care Needs Services Plan Division, Michigan Department of Community Health.


In this session, the presenters discussed key design and operational issues faced by States in developing and sustaining provider networks for children with special health care needs (CSHCN).

Dann Milne from the Colorado Department on Healthcare Policy and Financing discussed the Colorado Safety Net Project, which was designed to improve service delivery and care while providing coordination of services for CSHCN in managed care. Developed with an emphasis on collaboration between agencies, consumers, community-based organizations, and providers in recognition of the fact that health maintenance organizations often do not serve CSHCN adequately, the project is designed to:

  • Develop care coordination systems.
  • Develop contracts and other relationships.
  • Eliminate duplication of and fill gaps in service.

The Safety Net Program has had positive results and has given the State some valuable insights, including:

  • The importance of parent advocates in the process.
  • The effectiveness of collaborative problem solving.
  • The need for multiple ways to identify CSHCN.

Jane Finn, the Director of the Children's Special Health Care Needs Services Plan Division of the Michigan Department of Community Health, spoke about the development of provider networks in the context of the two managed care models being used in Michigan to serve CSHCN. The two heath plans are specifically designed to bring coordination and accountability to a full range of benefits for CSHCN.

Ms. Finn highlighted the Michigan requirements for providers and provider networks, which include:

  • A full array of specialty and primary services.
  • Facilities for care located near members' residences.
  • Coordination of care by a pediatric subspecialist.
  • Experience with the CSHCN population.

Ms. Finn also discussed some important lessons that the State of Michigan has learned in the process of developing effective provider networks for CSHCN. Some of the most important lessons include:

  • Contracting with providers requires ample time.
  • Some providers in CSHCN networks may not want (or be able) to contract with managed care plans.
  • CSHCN contracts may not be priority contracts for potential providers so enticements may need to be used.
  • Partnerships are critical—the State must be willing to work together with CSHCN managed care plans to provide effective services for the population.

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