The Monterey County Health Initiative: A Post-Mortem Analysis of a California Medicaid Demonstration Project

Twenty months after the California State Department of Health Services turned its Medicaid program in Monterey County over to a local health care authority, the Monterey County Health Initiative (MCHI), the state terminated the pilot project in favor of a return to fee-for-service reimbursement. The...

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Bibliographic Details
Published in:Medical care 1987-01, Vol.25 (1), p.35-45
Main Author: Aved, Barbara M.
Format: Article
Language:English
Subjects:
California
Contract management
Cost Control
Fees
Health care costs
Health care delivery
Health Services - economics
Health Services - statistics & numerical data
Hospital costs
Medicaid
Medicaid - economics
Medical case management
Patient care
Physicians
Pilot Projects
Primary health care
Primary Health Care - economics
Primary Health Care - organization & administration
Regional Medical Programs - economics
Reimbursement Mechanisms
Utilization Review - economics
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Summary:Twenty months after the California State Department of Health Services turned its Medicaid program in Monterey County over to a local health care authority, the Monterey County Health Initiative (MCHI), the state terminated the pilot project in favor of a return to fee-for-service reimbursement. The MCHI, plagued from its inception with shaky provider support and a flawed program design, failed to demonstrate its anticipated cost savings. The key features of this failure were overly generous fees for primary case managers, inadequate utilization control measures, a general hesitancy to assume the necessary gatekeeper function, and a management information system that was not fully operational until well into the implementation of the program. Policy implications and recommendations for future state-sponsored Medicaid demonstration projects are discussed.
ISSN:0025-7079
1537-1948
DOI:10.1097/00005650-198701000-00005