Managed Care - November 2008 - (Page 45)

PLAN WATCH didn’t know,” says Forshee. “The conceptual value of an annual exam for the African-American male didn’t really exist.” All about knowledge It came down to getting the knowledge to the enrollees, or taking enrollees to the knowledge. “Education was something we could do something about,” says Forshee. Molina brought together groups of PCPs, took their photographs, and then sent the pictures out to patients who were missing out on preventive services. Which brings us to the most important piece of the program: focus groups of physicians and focus groups of Medicaid recipients. “Those were how we got answers,” says Forshee. Of course, you have to provide a little incentive for someone, especially a busy doctor, to participate. Forshee says the idea of improved outcomes served as an attraction. Also, the insurer fed them. “And at those three dinner meetings, we actually took the time with the providers we identified in southeast and west Michigan to share the unsettling data and discuss with them potential solutions,” says Forshee. The patients got involved in the program thanks to the efforts of Patrick C. Jackson, MBA, the program coordinator of the minority health section at the Michigan Department of Community Health. Jackson, no longer at MDCH, focused specifically on health disparities, says Forshee. “He was well known and had health care experience,” he says. “We told members what we were doing, brought them together, and provided a meal. We also provided transportation. We got them into those focus groups.” That led to success. “It is definitely a partnership,” says Forshee. “And the partnership needs to be with those who have the ability to have an impact on individuals that are your target population. We did the right things by knowing who our patients are and explaining to them that this is about African-American male health issues. Telling them that they have a chance of being part of solving a problem.” Although the particular hurdles overcome by “Check Up or Check Out!” have to do with the particular market in which Molina launched it, there are lessons for all medical directors, says Forshee. “I think one of the pitfalls administrative physicians and others make is that we assume we understand the mindset of the people we are creating programs for,” says Forshee. “That assumption gets us into trouble. Using focus groups, we find out that the mentality of the individuals who are in that situation is different from those of us who are trying to go to work in an administrative job day-in and day-out. Using focus groups is very important, especially in Medicaid.” Forshee says the program should be transferable to other health plans and markets that serve Medicaid recipients. In the meantime, Molina is expanding it to two cities in western Michigan. Inexpensive “Check Up or Check Out!” has the extra benefit of being inexpensive. Forshee estimates that it cost Molina about $20,000 to launch the program, not counting the hours worked by employees of the insurer. “This is what managed care should do,” says Forshee. “If we promote good, preventive health care, that will lead to higher quality and cost avoidance. If we can get people with hypertension in before they have their first stroke, what a phenomenal thing. If we can get people in with prostate problems early, get colorectal screening early, and get people in with early diabetes, we can prevent the known complications and occurrences which come from late detection and treatment of these diseases.” The potential benefits are far too great to not try something like “Check Up or Check Out!” says Forshee. “Preventive services are foundational to managed care and the more that we can help empower individuals and inform them of what the risks are and what the needs are for their general wellness and for their health, then the better we’ll do as a society and the better we’ll do as a managed health plan.” MC Education about what goes on during a physical proved crucial in luring more Medicaid recipients to the doctor’s office, says James Forshee, MD, chief medical officer at Molina Healthcare of Michigan. NOVEMBER 2008 / MANAGED CARE 45

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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