MCOs often use primary physicians as gatekeepers to help ensure that patients receive the most appropriate care and to promote coordination of care at the most appropriate level. The concept of a primary physician offers an interesting model for early care and education. Under the current system there is no assurance that these teachers and caregivers communicate with one another or coordinate service delivery. In Head Start, the family worker might be assigned this role. A similar individual could take responsibility in a pre-kindergarten or early intervention program or a child care center.
Many states currently contract with non-profit agencies to administer child care subsidies.
There are, however, some important differences between child care management agencies and managed care organizations. First, MCOs have the authority to select a limited pool of providers from whom they will purchase services. Consumers must select a health care practitioner who participates in the MCO network. Second, MCOs have the flexibility to negotiate rates with the practitioners in their network, and they typically use a variety of payment methods and rate-setting methodologies. It is not uncommon for rates to vary widely among types of practitioners and locations.