Academic journal article Journal of School Health

Managed Care Organizations and Public Health: Exploring Collaboration on Adolescent Immunizations

Academic journal article Journal of School Health

Managed Care Organizations and Public Health: Exploring Collaboration on Adolescent Immunizations

Article excerpt

Three legislative statutes laid the groundwork for collaboration between managed care organizations (MCOs) and public health agencies in Minnesota. MinnesotaCare legislation, which provided improved access to health care for Minnesotans, mandated that MCOs submit annual reports to the Minnesota Department of Health describing how they serve high-risk, special-needs populations.[1] Another mandate required that Medical Assistance patients be enrolled in managed care.[2] A third mandate required that Minnesota MCOs be non-profit, therefore not subject to the perceived conflicts of for- profit MCOs in other parts of the country.[3]

This legislative action provided an environment for additional activity within the public and private sector, which has encouraged collaboration between MCOs and public health. In Minnesota, MCOs follow mission statements that reflect their commitment to community health: "To improve the health of our members and the community"[4]; "An innovator in community health improvement"[5]; and "Services that improve the health of individuals and their communities."[6]

The Minnesota Council of Health Plans, a network of Minnesota MCOs founded in 1985, provides framework for MCOs to collaboratively pursue a variety of issues. One such area of mutual interest is population health improvement. The Immunization Task Force of the Minnesota Council of Health Plans develops initiatives aimed at improving immunization rates in all children, not just health plan members.

The "churning" of MCO membership supports the logic that health plans can work together, rather than in competition, on improving population health. Churning occurs for various reasons. Employers may change the health coverage for employees, which results in individuals changing health plans. As they gain and lose Medicaid eligibility, individuals with Medicaid coverage may switch from plan to plan, re-enrolling each time with a different plan.

PROGRAM PLANNING

In 1993, the Minnesota Public Health Association sponsored public- and private- sector discussions to explore ways of partnering around population health goals, as encouraged in the original MinnesotaCare legislation.[1] These discussions gave birth to the Population Health Initiative that focused on the manner and means by which public and private organizations could join together to meet their own organizational goals, as well as larger common goals.[7] This process addressed three questions. How can private-sector organizations, which compete in providing individual medical services, find a way to cooperate on population-based health strategies? What are the discrete roles and responsibilities of various organizations within the public sector, including local, regional and state agencies? How can public and private organizations go about collaborating to achieve population-health goals?

In 1995, the Population Health Initiative issued a report recommending continued support for a forum that could serve as a convening point. This led to the formation of the Center for Population Health, a 501(c)(3) that is a creative locus for study, discussion and collaboration between public and private stakeholders on health improvement.

The Center for Population Health is associated with three pilot-project "workgroups" composed of members from MCOs, local and state public health departments, local hospitals and clinics, and the state hospital association. These workgroups serve as forums to explore issues public and private organizations face when they collaborate on population health improvement. The East Metro (St. Paul area) Health Promotion Cooperative focuses on promoting children's use of bike helmets. The West Metro (Minneapolis area) Workgroup focused on adolescent health, specifically hepatitis B immunizations. A non-metro Minnesota task force has not yet convened.

The West Metro Workgroup met once a month for approximately two years. …

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