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Summary: Provider Health Care Reform Workshops

The first provider health care reform workshop was held in Baltimore, Maryland, November 30 and December 1, 1995. Providers of substance abuse treatment services from States that have attained an operational level of working in health care reform were invited to participate. Treatment providers from the following States attended: Arizona, Iowa, Massachusetts, Minnesota, Nebraska, North Carolina, Oregon, and Washington. Presentations were limited to 10–15 minutes each and were followed by open discussion among the participants. Presentation and discussion session topics included new challenges and responsibilities for providers in a health care reform environment; appeals, grievances, and provider monitoring of managed care organizations; integrated systems of service delivery and provider networks; PPC and appropriate levels of care; provider perspectives on health care reform; consumer report cards; advanced survival skills; and financial and risk issues.

The second and third provider health care reform workshops were held for substance abuse treatment providers from States that have begun implementing health care reform for substance abuse treatment services for Medicaid and other publicly supported clients. Because of the number of States that are at the implementation level, and because of CSAT's desire to keep the workshops relatively small and informal, providers from eastern States were invited to the second workshop and providers from western States were invited to the third. The second provider health care reform workshop was held in Nashville, Tennessee, March 27 and 28, 1996. Participating providers came from Connecticut, Delaware, the District of Columbia, Florida, Maryland, New York, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, and Virginia. The third provider health care reform workshop convened in Dallas, Texas, April 25 and 26, 1996. Providers from Hawaii, Kansas, Louisiana, Michigan, Missouri, Ohio, Oklahoma, Rhode Island, South Carolina, Texas, West Virginia, and Wisconsin participated in this workshop.

Topics covered in these implementation-level provider workshops included critical issues particular to each State's health care reform implementation efforts, a historical overview of managed care, positive and negative aspects of managed care today, critical issues in contract development, comprehensive section 1115 demonstration projects (Medicaid waivers), State and MCO contracts, uniform PPC, new responsibilities and provider readiness, identifying and assessing important treatment outcomes, developing provider networks and integrated systems (the Arizona model), and maintaining the service continuum for special populations.

The fourth and fifth provider health care reform workshops were held for treatment providers from States that are planning health care reform for substance abuse treatment services. Because of the number of States that are at the planning level, and because of CSAT's desire to keep the workshops relatively small and informal, western States participated in the fourth workshop and eastern States participated in the fifth. The fourth provider workshop was held in Park City, Utah, on June 27 and 28, 1996. Participating providers came from Alaska, Arkansas, Colorado, Idaho, Montana, Nevada, North Dakota, South Dakota, and Utah. The fifth and final provider health care reform workshop was held in Chicago, Illinois, July 25 and 26, 1996. Treatment providers from the following States, commonwealths, and territories attended: Georgia, Illinois, Kentucky, Maine, Mississippi, New Hampshire, New Jersey, Puerto Rico, and the Virgins Islands.

Table 2. Provider Health Care Reform Workshops

^aRange = 3.11–3.58; average = 3.37.

Topics covered in these planning-level provider workshops included managing organizational changes under health care reform; new responsibilities and provider readiness: determining capitation rates and other financial considerations; critical issues in the development and management of contracts with managed care organizations; Medicaid waivers and Federal funding after health care reform; developing provider networks and integrated systems (the Arizona model); identifying and assessing important outcomes; uniform PPC; and maintaining the service continuum for special populations.

For these five workshops, treatment providers came from 47 States, the District of Columbia, Puerto Rico, and the Virgin Islands. Twenty individuals either gave presentations or facilitated discussion sessions, and there was a total of 55 presentations and discussion sessions. The workshops had a combined attendance of 202 individuals. The reader should refer to specific workshop executive summaries for agendas and lists of participants.

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