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  • Title: Clinic provision of contraceptive services to managed care enrollees.
    Author: Frost JJ.
    Journal: Fam Plann Perspect; 1998; 30(4):156-62. PubMed ID: 9711452.
    Abstract:
    CONTEXT: Since the initiation of managed health care, little information has been available on whether family planning agencies are seeking ways to serve (and obtain reimbursement for serving) the growing number of clients who are managed care enrollees. METHODS: A 1995 mail survey sought information from a nationally representative sample of publicly funded family planning agencies about the agencies' involvement with managed health care plans and related clinic services, policies and practices. Completed surveys were received from 603 agencies, for an overall response rate of 68%. RESULTS: One-half of all publicly funded family planning agencies had served known enrollees or managed care plans. One-quarter (24%) had served managed care enrollees under contract, while others sought out-of-plan reimbursement for services provided to enrollees (13%) or used other sources to cover the cost of these services (12%). Family planning clinics administered by hospitals and community health centers were more likely than other types of clinics to have contracts to provide full primary-care services to managed care enrollees, whereas Planned Parenthood affiliates were more likely to have contracts that covered the provision of contraceptive care only. Clinics administered by health departments rarely had secured managed care contracts (10%), and only 36% reported even serving managed care enrollees. CONCLUSIONS: The challenges presented by managed care, and agencies' responses to these challenges, vary according to the type of organization providing contraceptive care. Family planning agencies need to seek relationships with managed care organizations based on those services that their clinics can best supply. By the mid-1990s, 73% of insured private-sector employees in the US and 40% of Medicaid recipients were enrolled in a managed health care plan. To determine whether US family planning programs are serving managed care clients and receiving reimbursement, a survey was mailed in 1995 to a nationally representative sample of 885 publicly funded agencies. Completed surveys were returned by 603 agencies (68%). Half the agencies had served known enrollees of managed care plans; 24% had served managed care enrollees under contract, 13% had sought out-of-plan reimbursement for services provided to enrollees, and 12% had used other sources to cover the costs of these services. 47% of hospital-based family planning clinics, 43% of those affiliated with community health centers, 31% of Planned Parenthood affiliates, 20% of independent agencies, and 10% of health department agencies had at least one contract with a managed care plan. Family planning clinics administered by hospitals and community health centers were most likely to have contracts to provide full primary care services to managed care enrollees, while Planned Parenthood affiliates tended to have contracts that covered contraceptive provision only. In general, agencies reported that contracts with private plans placed more restrictions on enrollees (e.g., in terms of preauthorization, treatment plans, and use of specific laboratories and pharmacies) than contracts with Medicaid managed care plans. Confidentiality concerns and a desire to maintain long-standing clinical relationships were identified as the main reasons enrollees of managed care plans continued with out-of-plan providers. Overall, 49% of agencies surveyed expected further expansion of managed care to have a negative impact on their program. Family planning agencies must seek ways to continue to provide timely, confidential, and comprehensive contraceptive care as they work within or around the restrictions and requirements of managed care plans.
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