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Access to care is a major concern for the dental profession and legislators at all levels of government. In recent years, workforce issues have come to dominate debates about improving access to care. One proposed solution to this dilemma is to provide more dental providers in the form of mid-level providers. The success of this new level of provider hinges on whether or not the practicing dentist will embrace the concept of utilizing mid-level providers to treat those who are economically disadvantage and/or reside in remote rural communities. Further, this model of care must be profitable in order for it to be successful. In turn, the Medicaid system must be attractive to dentists. The Pew Foundation has issued a report supporting the mid-level provider model and its potential to be profitable to dentists. Opponents point to issues of level of education, state subsidies, confusing regulation, liability, and financial feasibility as reasons to reject the mid-level provider model. The American Dental Association asserts in its report, “The Role of the Workforce,” that the U.S. dental workforce is adequate for now and for the foreseeable future. The ADA further states that the Pew Foundation’s conclusions about the potential role of mid-level providers are flawed and can lead to erroneous conclusions regarding the contribution mid-level providers would make toward accessing care. An analysis of key variables and financial considerations raises serious concerns and questions about mid-level provider model as a cost effective solution to accessing care.

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation. [ABSTRACT FROM AUTHOR]

The article presents the authors' experiences on developing an economically sustainable depression care management program within Colorado Access, a non-profit Medicaid health plan. The authors discussed high rates of mental health issues, medical complicities and psychosocial barriers to mental health care. They discussed how the company redirected resources to incorporate depression care management into an intensive care management program. The authors say that a targeted group of high cost Medicaid recipients were managed through Colorado Access program.

The evidence base for behavior management techniques and philosophies targeted toward children changes over time to incorporate new information and reflect evolving societal and professional norms about what is effective, appropriate, and acceptable. New evidence may suggest certain techniques are more or less effective than previously assumed. Approaches that may have been the standard of care 20 years ago may no longer be appropriate or tolerable for children or their parents. As professionals, dentists are obligated to keep their knowledge and skills current and incorporate these approaches into their practices, as appropriate. A dentist's ability to do so may be facilitated or hindered by a number of factors. Reimbursement for behavior management services potentially has a significant influence in changing accepted practice. The compensation received for one time and effort in providing behavior management services will be assessed against the costs of providing them, including the opportunity costs associated with not doing something else. In some instances, the cost of such care will be fully reimbursed by a third party.

BACKGROUND: * Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors. METHODS: * We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction with Medicaid managed care, traditional Medicaid, and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale. RESULTS: * The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care. CONCLUSIONS: * Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality. [ABSTRACT FROM AUTHOR]