Public hospitals and substance abuse services for pregnant women and mothers: Implications for managed-care programs and medicaid

Although an increasing proportion of the US population receives health serv ices through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large parr to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provid er group with experience in caring for this population, the member universe of the National Association of Public Hospitals and Health Systems. The su rvey requested detailed information on hospital system information, current managed-care arrangements, outcome measurements, financing, service priori ties, and service availability. The 81% response rate (n = 95) identified 3 5 hospital systems providing services to an average of 998 women in 1997. T he majority of these systems (69%) reported coordinating rare for these pat ients, but only 26% reported they computerize patient charts. Most use at l east one indicator to measure effectiveness, and 50% use at least four. Cou nseling/education and transportation were seen as key support services, but many acknowledge they are not reimbursed for critical services such as nut rition education. The discussion highlights the need to provide formal supp ort for core support services, to assist in care coordination and provide i ncentives for developing more sophisticated information, and To specify rel ated services in the state Medicaid contract language.