Abstract
Abstract: In the mid-1990s TennCare replaced Medicaid in Tennessee and extended health coverage to uninsured and uninsurable adults and children. Throughout its short history many management and financial problems have plagued it. In spite of this, Tennessee currently provides health coverage to more persons compared to most states. It is clear that managed care for the poor was not designed to provide disease management; it was designed to provide cost management. Many tangible and intangible factors affect an individual's ability to access health care or to engage in behavioral practices that promote health and prevent disease. Being of low-income and minority status have been historically associated with barriers, including obtaining or accessing health care, making lifestyle changes to prevent poor health, or complying with medical treatment. This article provides the public health perspective of a hypothetical model that extends the managed care model to one of health management for the poor and underserved.
PEOPLE OF LOW INCOME and minority race/ethnicity are disproportionately affected by chronic disease and poor health. Because of environmental and personal barriers, these individuals historically have had difficulty accessing health care, adopting lifestyle changes to prevent disease and disability, or being compliant with medical treatment plans. Over the past 10 years many states have adopted managed care models in an effort to reduce the costs associated with caring for the poor. This article provides an overview of how Tennessee has approached management of health care for the poor, reviews indicators of the quality of care for specific chronic conditions among TennCare enrollees, and addresses the socioeconomic and cultural influences that challenge the effectiveness of managing the care for the poorest of the poor. Recommendations are made regarding the need to develop new approaches that primarily focus on prevention, disease management, and the establishment of linkages between organizations to improve health while decreasing the burden of care on the community.