Managed Care in the Inner City

DENNIS P. ANDRULIS is director of the Office of Urban Populationsat the New York Academy of Medicine. He is a contributing editor tothe American Journal of Medicine and a founding board member of theAmerican International Health Alliance, which creates health carepartnerships with U.S. and Central and Eastern European providersof health care. He has published extensively on a broad range ofhealth policy issues. Andrulis is former president and CEO of theNational Public Health and Hospital Institute. BETSY CARRIER isvice president for managed care at the National Association ofPublic Hospitals & Health Systems and has worked in health caremanagement for over 20 years. She has extensive experience indeveloping managed care plans and case management programs forindividuals covered by both Medicaid and commercial insurance.

• Tables and Figures. Preface. Acknowledgments. The Authors. Chapter 1: Managed Care and the Ecology of the Inner City. The Inner City Environment. Access to the Health System. Chapter 2: Managed Care, the Safety Net, and Inner CityResidents. Managed Care Organizations: Benefits and Concerns for the InnerCity. Managed Care Respond to Inner City Populations and Their HealthCare Needs. Safety Net Providers, Managed Care and VulnerablePopulations. Chapter 3: Implementing Managed Care in the Inner City. Community Health and Public Health Issues. Physicians and Allied Health Professionals. The Traditional Providers of Care in the Inner City and TheirIntegration with Managed Care. Chapter 4: Integrating Urban Teaching Hospitals into ManagedCare. Old Questions, New Issues for Urban Teaching Hospitals and TheirMedical Schools. Urban Teaching Hospitals and Managed Care: Results from a NationalSurvey. Chapter 5: Financing Managed Care for Urban Populations. Capitation Rates, Risk Adjustment, and Adverse Selection. The Challenges of Attaining Stability in Enrollment. The Special Circumstances of the Uninsured. The Threat and the Opportunity for Inner City Safety Net Hospitals.

"Managed care is a two-edged sword for vulnerable residents of theinner city and the providers that serve them. Managed Care in theInner City provides a balanced and scholarly analysis of thepotential of managed care concepts for Medicaid patients and theuninsured. This book should be read by policymakers at the local,state, and national levels and by providers in public hospitals andcommunity health centers." (Ron J. Anderson, president and CEO,Parkland Health & Hospital System) "If we think of managed care as representing a kind of globalwarming for indigent-care eco-systems, then our urban healthsystems are indeed among the most Andangered. This timely bookprovides us with valuable information and insight with which tounderstand the nature and extent of jeopardy urban health careproviders are facing. In addition to providing a candid andthoughtful diagnosis, the authors go much further by identifyingsome of the concrete strategies and tactics being employed forsurvival in this environment and posing some critical policyquestions that simply cannot be avoided." (Robert Hurley, associateprofessor, Medical College of Virginia) "In this book Dennis Andrulis and Betsy Carrier examine the claimsmade on behalf of managed care and pose unsettling questions as towhether this new cure will really work or only make matters worsefor inner-city residents. The authors, who come from thepublic-hospital sector, are measured and fair in the treatment oftheir subject." (Health Affairs)