Concerns about managed care's impact on the quality of care delivered to specific racial and ethnic populations are raised in a report commissioned by the Joint Center for Political and Economic Studies and authored by David Nerenz, Ph.D., of Henry Ford Health Systems. Guided by recommendations from African American and Hispanic community leaders and health quality experts, Nerenz is leading an effort to identify a set of performance measures that focus on care provided to minority Americans. Despite efforts by some states and health plans, many Medicaid beneficiaries are unfamiliar with managed care and lack sufficient knowledge to navigate the system effectively. Sue Kaplan at New York University and Christine Molnar at the Community Service Society of New York are conducting a national review of consumer education projects aimed at the beneficiaries of Medicaid managed care. The model is being tested further in Los Angeles, New York, and Philadelphia.
Public hospitals are a major source of care for minority and uninsured patients.
Work over the past year shows that increased market competition, lower reimbursement, and reduced federal payments are curtailing the ability of safety net hospitals to provide care to uninsured patients, even as the number of those patients grows. In one of a series of papers examining the future of safety net providers, Lynn Fagnani and Jennifer Tolbert at the National Association of Public Hospitals describe providers' dependence on Medicare and Medicaid disproportionate share hospital payments and discuss the implications for those institutions. The impact of managed care on urban safety net hospitals has also been the focus of analyses by Darrell Gaskin, Ph.D., at Georgetown University. His work shows that, although public hospitals are losing revenues as managed care plans channel private and Medicaid patients away from them, these institutions tend to remain the main source of essential medical services within their communities. To support the development of professional and academic leaders, the program provides an enriched course of study at Harvard University to a select group of promising physicians with a commitment to minority health.