An evaluation of a policy mandating memoranda of understanding between Medi-Cal managed care plans and local public health departments in California.

摘要

Collaboration between public health and managed health care has been strongly promoted in recent years, yet information about mechanisms that foster these partnerships is lacking. An evaluation was conducted to examine the effects of one strategy for promoting collaboration: mandating memoranda of understanding (MOU) in nine program areas (STD, HIV, TB, immunization, family planning, MCH, EPSDT, WIC, and children with special medical needs) between managed care plans providing Medicaid services (MCMC) and local public health departments (LPHD) in twelve counties in California. The literature regarding collaboration between the MCMC and public health sectors, and theoretical and empirical evidence on factors that promote inter-organizational collaboration was reviewed. Three qualitative and quantitative data collection methods were used: archival review, self-administered mail surveys, and structured telephone interviews. Relationships between ten indicators of successful collaboration, four explanatory variables, and five covariates were examined using bivariate and logistic regression techniques. Results indicated the organizations have been successful in collaborating to create the MOUs. Approval by the state was influenced by the type of health plan, type of MOU, time since submission, time since start-up of MCMC plan, and type of guidance provided by the state. The approval process was found to be problematic. Implementation was associated with the type of MOU, time since submission, time since start-up, and LPHD size. The MOUs have promoted collaboration in four of six types of collaborative activities examined. A positive impact on perceived quality of health care services, but no impact on public health services was reported. Billing the MCMC plan by LPHDs is associated with type of MOU but not type of health plan. The percent of bills fully reimbursed is high. A majority (78%) of survey respondents support continuation of the current state policy. In conclusion, the study provides evidence that supports continuation of the current policy but also identifies a need for improvement in the process of approval of the MOUs. Previous findings concerning the importance of internal organizational factors on the capacity of organizations to engage in interorganizational collaboration were supported. Recommendations to the state of California and local agencies were generated.