• Understanding Managed Care
• Glossary
• Basics
• How to Pick a Plan
• How to Evaluate Your Current Plan
• Strategies for Mangaing Your Health Care
• What to Look for in Health Care Providers
• Qualifications
• Physical Access
• Communicate Access
• Financial Access
• Qualitities and Attitudes
• Rating Providers
• Dangerous Warning Signs
• Resources for Choosing Health Care Providers
• Active Consumer
• Medicare and Medicaid
• Medication
• Disability-related Issues

• General
• Children with Disabilities
• Developmental Disabilities
• Mental Health
• Physical Disability
• Older People
• Speech
• Spinal Cord Injury
• Advocacy Issues
• Advocacy Resources
• Medical Information
• Research Projects
• Other Resources
• California Resources
• Submitting Additions and Updates

Understanding Managed Care

How to Pick a Plan

• develop and test questionnaires that assess health plans and services
• produce easily understandable reports for communicating survey information  to consumers, and
• evaluate the usefulness of these reports for consumers in selecting health care plans and services

NCQA's Health Plan Report Card - 01/26/05   has results on hundreds of managed care organizations that care for commercially insured individuals and Medicare and Medicaid beneficiaries. You can create a customized Report Card that shows results for the health plan or plans you want to know about.

Managed Care  questions to consider when choosing an HMO.

Managed Care Regulations by State  01/26/05 

Your Guide to Managed Care Contains section on picking a plan. 01/26/05 

Administrators in Medicine operate, an organization of state medical board directors, operates a Web site where you can find information on doctors in a growing number of states. This information includes disciplinary actions, but not malpractice histories (USA TODAY, May 19, 1997, P.3A).

Books:

Choosing and Using an Hmo (Bloomberg Personal Bookshelf), by Ellyn Spragins, Hardcover - 255 pages (November 1997),  Bloomberg Pr.

Table of Contents

• 1 The Hunt for Quality Cost and convenience count, but quality of care is what keeps you happy. Here's how to find it
• 2 The Eleven Indicators of Excellence To distill a huge array of information, concentrate on these measures of superiority
• 3 Digging Deeper After you find  the "best" HMOs, see if their specific strengths match your needs
• 4 Special Care: Chronically Ill and Seniors If your demands are constant and focus on prevention, the search gets tougher
• 5 Who's the Best Doctor? Word of outh is not enough. Here's help for checking out certifications, credentials, and complaints
• 6 Getting the Most Out of Your Plan What strategies can you use when you feel thwarted by your HMO?
• 7 Challenging Your HMO Getting the most out of Medicare HMOs and legal remedies
• STATE - BY - STATE GUIDE TO THE BEST HMOs

The Bloomberg Personal Bookshelf is a series of print products on personal finance that have been converted to 3-hour, two-cassette abridged audiobooks by DH Audio. Choosing and Using an HMO is an essential guide to a very difficult topic. The author has done a good job organizing her information, writing it and reading the final products. Spragins comes off as an expert. Furthermore, she successfully argues that the consumer needs this information. Anyone starting a family could benefit greatly HMO audiobook. It covers a lot of ground in a well-organized way. The audio is accompanied by a booklet of resources, worksheets and summaries. M.P. ©AudioFile, Portland, Maine.

The Complete Idiot's Guide to Managed Health Care (Complete Idiot's Guides), by Sophie M. Korczyk, Hazel A. Witte, Paperback - 300 pages (January 1998), Alpha Books

Table of Contents

Part 1: Getting Your Bearings

• 1  What Managed Care Means to You You and your doctor are not alone.
• 2 Your Plan from the Inside Out Lining up the players.
• 3 The Informed Consumer Gets the Best Health Care Your rights, your records, your questions.
• 4 The Home Health Bookshelf Reading, research, and the Internet.

• 5 More Than a Paycheck: Choosing Health Care Coverage Through Your Job What it covers,  what it costs.
• 6 Getting the Most for Your Money: Evaluating Plan Quality Understanding your plan's report card.
• 7 Passages: From Job to Job, and from Job to the Unknown Maintaining coverage during life's big changes.
• 8 Managed Care for Seniors It all changes  at age
• 9 Beyond the Big City: Managed Care in Rural Areas How the other 20 percent lives and heals.
• 10 Medicaid Using your safety net.

• 11 Primary Care: The Gateway to Health Care Your primary care doctor as your guide.
• 12 Preventive Care An ounce of prevention is already paid for.
• 13 Men Are from Mars, Women Go to the Doctor Do we really use health care differently? Yes.
• 14 Emergency Care: Smart Moves and Common Sense When to go, what to do, and what to say.

• 15 Maternity Care: Nine Months and Counting Staying in charge of the big event.
• 16 Living with It: Chronic Conditions What your plan can do to help you stay well.
• 17 When the Unexpected Happens: Injuries and Illness Specialty treatment and rehabilitation.
• 18 More Than Standard Treatment Your life and health at the frontiers of medical knowledge.
• 19 Mental Health and Substance Abuse Treatment Navigating a different system.
• 20 When You're Out of Town How to take your plan with you.
• 21 Stepping Up to Bat: The Rest of Your Health Care Team Alternative treatments, health club discounts, and more.

• 22 Your Life on File What they know and what you should know.
• 23 When You Disagree: Working the System You can get them to listen.
• 24 Court as a Last Resort What to expect.
• 25 Who's Minding the Store: Regulation and Accreditation Your plan has to answer to a higher authority

Health Insurance : How to Get It, Keep It, or Improve What You'Ve Got, by Robert Enteen, Paperback - 307 pages 2nd edition (July 1996), Demos Vermande.

Table of Contents

1.   Health Insurance Basics
2.   Health Insurance Needs
3.   The Options Checklist
4.   Group and Individual Plans
5.   Blue Cross and Blue Shield Plans
6.   HMOs and PPOs
7.   Health Insurance "Pools" for "High-Risk" People
8.   Long-Term Care Insurance
9.   Short-Term Plans
10. Hospital Indemnity and Specified ("Dread") Disease Plans
11. Federal Employees Health Benefits Program
12. Veterans' Benefits
13. CHAMPUS (Civilian Health and Medical Program of the Uniformed Services)
14. CHAMPVA: Department of Veterans Affairs)
15. Medicare
16. Medicare Supplement ("Medigap")
17. Medicaid
18. Free and Low-Cost Care for the Poor
19. Continuation and Conversion of Coverage When Leaving an Employer Group Plan (Regular and Special "COBRA Options")
20. Maximizing Claims
21. Sources of Help When You Have Insurance Problems

App.

1. Definitions of Health Insurance Terms
2. State Populations and the Percentage Uninsured
3. State Health Care Reform Efforts
4. State Reforms That Could Affect Programs for People with Disabilities
5. Preexisting Conditions and Health Insurance
6. States with Risk Pools and Open Enrollment Plans
7. Blue Cross and Blue Shield Plans
8. State Risk "Pool" Contacts
9. State Insurance Departments
10. State Agency Sources of Information on Long-Term Care Insurance
11. Insurance Committees of State Legislatures
12. Legislative "Bill Rooms" by State
13. State Health Departments
14. State Veterans Affairs Agencies
15. Paralyzed Veterans of America (PVA) Chapter Roster
16. Medicare Peer Review Organizations (PROs) (Part A)
17. Medicare Carriers (Part B)
18. State Medicaid Agencies
19. State Workers' Compensation Agencies

How to Evaluate Your Current Plan

Medicare and Medicaid

HCFA's Managed Care Manual  Managed Care Resource Information Directory.

Medicare Health Plan Compare - (added 12/28/00) helps you obtain detailed information on Medicare's health plan options. By "comparison shopping," you can find the plans that are best for you. Different comparisons you can make for plans include:

• Cost and Benefits covered
• Quality of the plans in keeping members healthy or treating them when sick

Information on people leaving managed care plans

Medicare.Gov - official  U.S. Government Internet site for Medicare consumer information. It is designed to offer a variety of useful and easy to read information about Medicare.(added 12/17/00).

Medicare Managed Care - An on-line educational booklet.

Medicare Rights Center (MRC) - 01/26/05  national, not-for-profit organization that helps ensure that older adults and people with disabilities get good affordable health care..

Medication Assistance Programs - (added 12/17/00) provides detailed information about each company's assistance program, including the company's name, the program's address, the telephone and fax numbers, guidelines and notes, the health care provider's role, the patient's role, information needed to initiate enrollment, information regarding the amount of medication and how it is dispensed, refill information, the estimated response time, and limitations of the program.

For a $5 processing fee for each medication requested, the http://www.themedicineprogram.com site will assist the patient in the enrollment process. Patients without access to the Internet can contact a health care provider or a pharmaceutical company to receive information about medication assistance programs.

Other related sites include:

• http://www.familyvillage.wisc.edu

http://www.phrma.org/patients

Disability-related Issues

General

Guideline ClearinghouseTM - (added 12/28/00) public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (AHRQ) (formerly the Agency for Health Care Policy and Research [AHCPR]) in partnership with the American Medical Association and the American Association of Health Plans. Mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated  delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.

Health Benefit Plans and the ADA - (added 6/00)  by Cornell University.

How Will Managed Care Fit Into the Lives of People With Disabilities? An article from the Hattie Larlham Foundation.

Guidance on the application of the Americans with Disabilities Act of 1990 to disability-based distinctions in employer provided health insurance - (added 6/00)

This interim enforcement guidance sets forth the Commission's [EEOC] position on the application of the Americans with Disabilities Act to disability-based distinctions in employer provided health insurance.

Children with Disabilities

Developmental Disabilities

Issues in Adapting Managed Care Techniques to Developmental Disabilities.

Psychiatric Inpatient Stay for A Person with Developmental Disabilities.

Can Managed Care Work for the Developmentally Disabled? 10/11/98 resaching why link is not working!

Where Should We Stand On Managed Care?  Commonwealth Coalition for Community.

The National Clearinghouse on Managed Care and Long-Term Services and Supports for Adults with Developmental Disabilities and Their Families  Charting the Changing Tides of Managed Care and Long-Term Services.

MANAGED CARE and the Lives of People with Developmental Disabilities and their Families

Mental Health

Physical Disability

Older People

Speech

Spinal Cord Injury

A Guide to Managed Ccare for People with Spinal Cord Injury

Advocacy Issues

Do You Know Your Medical Rights?

Medicare failure to meet the needs of people with disabilities - especially non-elderly beneficiaries.  Includes discussion of Medicare standards for coverage of wheelchairs, scooters and other durable medical equipment. (Added 8/00)

Meeting The Needs of People With Chronic and Disabling Conditions in Medicaid Managed Care xxx fact sheet which discusses "carve-outs" and other methods used to address the health care needs of people with disabilities.

National Health Law Program - (added 6/00)  a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities.

Steps to Take If You Are Not Satisfied With Your Health Care Services

Books:

The Insider's Guide to Hmos : How to Navigate the Managed-Care System and Get the Health Care You Deserve, by Alan J. Steinberg,  Paperback - 256 pages (September 1997), Plume Books.

Table of Contents

1. What Is Managed Care?
2. The Problems with HMOs
3. The Problem of Capitation Capitalists
4. How to See the Best Specialists for Your Needs
5. Difficult Patients and the HMO Mentality
6. The Special Problems of Medicare HMOs
7. How to Choose the Safest and Best Health Insurance for Yourself and Your Family
8. How to Choose the Safest and Best HMO for Yourself and Your Family
9. Choosing the Best HMO Doctor for Yourself and Your Family
10. Getting Around Red Tape and Overly Self-reliant Gatekeepers, and Obtaining Proper Hospital Care
11. Your Pregnancy, Your Children, and Psychiatric Care
12. A View Toward the Future: Quality in Place of Profit

Health Against Wealth : Hmos and the Breakdown of Medical Trust, by George Anders, Paperback - 304 pages Reprint edition,  Chapters Pub Ltd.

From Amazon.com's  Review:

If you have ever sought pre-approval for a necessary medical treatment, or have had problems arranging appointments with a specialist, or have seen a personal-care physician transferred to a distant clinic, George Anders's book on the growth of health maintenance organizations (HMOs) will confirm your worst fears. A reporter for the Wall Street Journal, Anders provides a series of horrifying case studies: a six-month-old baby who loses his hands and feet after a 42-mile journey to an HMO-approved emergency room; residents of a small town in Tennessee afflicted with an outbreak of a painful bowel infection who find that the drugs needed to suppress the epidemic are not covered; HMOs that select hospitals with low success rates for heart-bypass operations because of cost factors. Anders presents a powerful indictment of the emerging managed-care model for our national health-care system in this disturbing book.
 

From Booklist , November 1, 1996
Anders' analysis of managed care has at its core the supposition that HMOs are the de facto national health care policy of the U.S. and will cover employer-, Medicare-, or Medicaid-funded health insurance for four out of five Americans by the year 2000. He notes that the "takeover" of health care by HMOs resulted from market forces seeking to contain costs in a bloated health delivery system, and this takeover came about without a single citizen referendum or congressional vote. This book is for any ordinary person seeking to understand the issues surrounding the explosion of HMO influence and to learn what HMOs do well and where they fail. Anders is forthright in his critique of HMOs. He identifies the worst problems in managed care and considers possible solutions. His premise is that people primarily seek health insurance in order to have some medical security in a crisis. The reality of that security is often in doubt as Anders, through numerous interviews, relates stories of experiences that individuals have had with HMOs in times of crisis. Anders suggests that employers may eventually bypass HMO middlemen by dealing directly with doctor and hospital groups that are well managed and committed to cost containment but are also committed to high-quality patient care.
Mary Whaley, Copyright© 1996, American Library Association. All rights reserved.
 

Advocacy Resources

• ADAPT's Community Attendant Services Act (CASA)
• Incitement Newsletter
• ADAPT's History
• Bulletins
• Upcoming Actions and Events
• Joining ADAPT
• ADAPT's Trainings
• Starting a Local Group
• Contacts
• Articles
• Brochures and Flyers

California Managed Health Care Improvement Governor's Task Force - Meeting the Needs of People with Disabilities Reccomendations drafted by Laura Remson Mitchell, Government Issues Coordinator, Multiple Sclerosis California Action Network.

The Center on Human Policy is a Syracuse University based policy, research, and advocacy organization involved in the national movement to insure the rights of people with disabilities. Site includes a helful group of disability-related links.

Center for Studying Health System Change (HSC) - (added 12/11/00) a non-partisan policy research organization which provides analyses about the effects of health system change to inform the thinking and decisions of policy makers in government and industry. HSC does not advocate policy positions, but is a resource for decision makers on all sides of the issues because of its reliable data and objective analyses.

Citizens for the Right to Know -  (added 12/17/00) a network of approximately 80 consumer and specific disease organizations representing hundreds of thousands of people across the country. Members share a common need -- access to quality information on health care plans in order to make informed consumer choices. The objective is to pursue basic consumer fairness in health care by requiring insurers, health service organizations and HMOs to provide people with necessary information on coverage principles, benefits and any exclusions or restrictions. Includes information on:

• managed care choosing a health plan which drugs are covered?
• glossary of terms
• newsletter
• health plan problems
• legislation

Data Guide: Using Data: A Guide for Community Health Activists - (added 12/28/00) An introduction to getting and using data for the data-shy. Guide discusses the value of using quantitative and qualitative data to score points with health care providers, funders and the media. It suggests where to go to get data, and describes some simple ways to present it and an appendix of specific sources for various types of  data.

Health Rights Hotline - (added 12/17/00) helps people take charge of their health care. Part of taking charge involves understanding your health care rights. Site provides some general information about your rights as a health care consumer. Although information is based on California law, it may still be useful even if you live in another area.

Disability Related Advocacy Links

National Organization of Physicians Who Care  provides legislative updates and other information regarding happenings in health care.
 

Medical Information

• Official American Medical Association (AMA) Home Page
• MedicineNet
• Medscape
• The University of Pennsylvania Cancer Center Resource
• The Parenting Community
• Thrive

• Hardin Meta Directory
• Medical Matrix

Texas Cancer Data Center (TCDC) provides online cancer information on health professionals, facilities and services, cancer statistics,
population, and community resources. TCDC is funded by the Texas Cancer Council, the state agency whose goal is to improve the availability
and quality of cancer services and information in Texas.

Research Projects on Managed Care and Disability

Research and Training Center on Managed Care and Disability  information about the NRH-RC/ILRU collaborative center.

Building Health Systems Grantees from the Center for Health Care Strategies (CHCS)

Medicaid Demonstration Project of New York State

Other Resources

Health, Wellness and Aging with Disability Reviews what is currently known regarding aging with disability; list new realities, new concerns regarding health, exercise, maintaining functional abilities, and many research questions; advocating for health reform and more; best practice information and guidelines; health services, assessment and evaluation guidelines; need for national information and dissemination network; role of independent living centers and other disability-related organizations; horror stories; and tips for weighing whether you'll use the gear; definitions; includes resource list (described below) and recommended readings.

Resource List: Wellness, Self-Care, Exercise & Aging with Disability Edition III

For people with disabilities and their families. Contains 165 entries with an author and subject index. Entries contain Type of information: Audio Cassette, Article, Bibliography, Book, Booklet, Listserve, Newsgroup, Newsletter, Registry, Report, Research and Training Center, Video, Web sites; Author; Length; date produced; content; cost; where to order or send for information; Phone / TTY / FAX / E-mail; and date entry added or updated.

Subjects covered include: Advocacy; Fitness Centers; What is Aging; Aging With Disability; Exercise; Exercise Videos; Health Care; Resources: Audio-Visuals on Aging, Centers for Independent Living, Clinics - Developmental Disabilities; Listserve (Internet); Newsgroups; Osteoporosis; Providers: Research & Training Centers (Aging with Disability, Developmental Disability, Spinal Cord Injury); Self-help Groups; Women Issues and much more.

Editon II is available at http://www.usc.edu/go/awd.

Health, Wellness and Aging with Disability

• General Information
• Cerebral Palsy
• Conferences
• Developmental Disabilities
• Exercise
• Polio
• SpinalCord Injury

Surgery on the Go Increasingly more procedures are done on an outpatient basis. Are you a candidate for outpatient surgery?

Health Care Choices for Today's Consumer : Guide to Quality and Cost,  by Marc S. Miller (Editor), Families United for Senior Action Foundation, Philippe Villers, Paperback - 457 pages Revised edition (August 1997), John Wiley & Sons.

Table of Contents
 

1. A User's Guide to Health Care Choices for Today's Consumer By Marc S. Miller
2. Healthy Living By Rena Convissor, Audrey Chang
3. Consumer Rights By George J. Annas
4. Health Insurance: Managing Managed Care By Nancy Turnbull
5. Primary Care By Harriet Tolpin
6. Hospitals By Joseph Restuccia, Alan Labonte, Jeffrey Gelb
7. Medications By Joe Graedon, Teresa Graedon
8. Parents as Health Care Consumers By Nora Wells
9. Women as Health Care Consumers By Martha Snyder Taggart
10. Men as Health Care Consumers By Jeffrey Kellogg
11. Elders as Health Care Consumers By Lou Glasse, Mal Schechter
12. On the Job: Health and the Workplace By Nancy Lessin, Laurie Stillman
13. Physician Specialists By June Ellen Mendelson
14. Mental Health By Cindy Brach, Gail K. Robinson
15. Long Term Care By Peggy Denker
16. Home Care By Anne P. Werner, James P. Firman
17. Caring for Your Teeth By Robert Krughoff
18. Buying Eyeglasses and Contact Lenses By Robert Krughoff
19. Alternative Health Care By Nicolas P. Carballeira
20. Death with Dignity By George J. Annas
21. Unreformed Health Care By Ron Pollack
22. Helping Yourself: A Guide to Self-Help Groups, Going Online, and General Resources for Health Care Consumers  By Martha S. Grover

California Resources

California Department of Managed Care - (added 12/18/00)

HealthScope - Pacific Business Group on Health (PBGH) California Consumer is an independent source of information to help select the best quality health plans, hospitals, and medical groups. (added 12/17/00)

Office of Statewide Health Planning and Development (OSHPD) - (added 12/28/00) a department of the California Health and Human Services Agency. Its mission is to plan for and support the development of health care systems, which meet the current and future needs of the people of