Managed Care and Homeless Populations
Linking the HCH Community and MCO Partners
Resource Topic: Capital Development, Finance, Governance, Special and Vulnerable Populations
Year Developed: 2019
Resource Type: Publication
Primary Audience: Administrative Staff
Board of Directors
C-Suite (CEOs, CFOs, CIOs, COOs, CMOs, etc)
Secondary Audience: Clinicians
National Health Care for the Homeless Council
(See other resources developed by this organization.)
Resource Summary: The brief includes the health care needs of this group, describes Health Care for the Homeless projects and the patients receiving care in these venues, a description of managed care, common goals between both entities, and issues that both providers and plans should consider when creating or strengthening partnerships. Because health care providers and insurance plans use different language, the terms “patient” and “member” are used throughout this brief to refer to the individuals being served.
Resource Details: As states and insurers are increasingly enrolling people who are homeless into managed care plans, new issues are emerging related to identifying individuals who have special needs, linking them to service providers, ensuring access to care, tracking quality of care and health care outcomes, and lowering total costs. At the same time, there is a broad community of health care providers who specialize in caring for homeless populations who are now navigating an insurance system for a larger proportion of their patients. These providers are seeing an expanded focus on enrollment and continuity of coverage, connections to specialty care, more time spent on meeting and reporting on quality goals, and navigating provider networks, prescription formularies, and other parameters of a managed care insurance system. This policy brief is intended to serve as a resource for all managed care entities (regardless of affiliation) looking to better understand homelessness, for health care providers seeking to be more aware of managed care and its interests, and for both groups to better understand the common goals each brings to a partnership.