Steve Rosenberg

Steven Rosenberg: Social Psychologist and Principal, Rosenberg Associates

How do you control for the Woodwork Phenomenon?, queried Steve Rosenberg.
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The goal of the afternoon session, which was facilitated by health care finance consultant Steve Rosenberg, was to reach consensus on a series of issues fundamental to financing school­based health centers.
...
-- Steve Rosenberg, Rosenberg & Associates

Is it possible, asked Rosenberg, for school­based health centers to avoid the undesirable but necessary choice that confronted community health centers in 1972?Will school­based health centers be forced to abandon their community­driven, social model of health care to secure a place within the current reimbursement system?Will we have to burn the village to save it?

The alternatives seem few.Consider this scenario offered by Rosenberg:

"Assuming the average cost of a comprehensive school­based health center serving a school with 1,000 students is $200,000, and all of the students are insured, the center would need a $16 per member/per month (pm/pm) rate to operate in a fully capitated environment."

Most panelists agreed that the market would not support such a rate.What, then, are the viable alternatives?

Rosenberg offered the possibility that the Omnibus Budget Reconciliation Act of 1995 might include provisions for a Medicaid block grant program, which could include a series of directives concerning use of Medicaid funds.One such directive might involve a federally mandated cost­based reimbursement (or carve out) for a defined transition period for community health centers and other federally qualified health centers (FQHCs).Rosenberg asked meeting participants if school­based health centers should be given the statutory right to be paid costs from all financing mechanisms -- as are FQHCs -- during this transition to full­blown managed care?Under such a scenario, school­based health centers essentially would operate as an independent system of care and would not be required to seek prior authorization when serving managed care patients.

The advantages of such an arrangement, according to Rosenberg, would be two­fold: 1) if the carve out were for a transitional period, that time could be used to establish a historical cost and data record, which is needed to create a managed care reimbursement rate structure; and 2) the carve out would give school­based health centers greater leeway in negotiating a role in their community's managed care systems.
...
Steve Rosenberg broadened that definition: "No gate keeping is a form of carve out.
...
But, Rosenberg warned, if school-based health centers refuse to play the federal reimbursement game, they will be left to rely primarily on local dollars.
...
The reluctance of school­based health centers to embrace cost­based reimburse-ment for their services reflects, according to Rosenberg, a conservative community.
...
Essential to the pursuit of these dollars, said Rosenberg, is the building of a political constituency sufficient to ensure a place at the bargaining table when difficult choices must be made about the division of diminishing local health dollars among community providers.
...
-- Steve Rosenberg, Rosenberg & Associates

By Luisa Buada, Steven Rosenberg, James Teevans, and Sheldon Weisgrau
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Steve Rosenberg, Principal, Rosenberg and Associates

by Luisa Buada, Steven Rosenberg, Gail Nickerson
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Steve Rosenberg, Principal, Rosenberg and Associates

Luisa Buada, Gail Nickerson, Steven Rosenberg, James Teevans
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Steve Rosenberg, Principal, Rosenberg and Associates

A report provided by: Luisa Buada, Gail Nickerson, Steven Rosenberg, James Teevans
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Steve Rosenberg is the Principal of Rosenberg and Associates, a consulting firm specializing in the strategic development of rural health care delivery systems.

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Steve Rosenberg, Principal,Rosenberg and Associates

Steve Rosenberg is the Principal of Rosenberg and Associates, a consulting firm specializing in the strategic development of rural health care delivery systems.

Moderating the conversation and reflecting on implications of various state strategies was Steve Rosenberg, the Program's long-time consultant on health care financing.
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Making the Grade consultant Steve Rosenberg commented that the market is continually asking, "What are you and prove to us you have value in the marketplace.
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The reflections of Steve Rosenberg on the strengths and weaknesses of the policy debates conclude the executive summary.
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"Do not," urged Rosenberg, "confuse political support, which also is essential to secure public dollars, with whether you provide a necessary service.

How do you control for the Woodwork Phenomenon?, queried Steve Rosenberg.
...
The goal of the afternoon session, which was facilitated by health care finance consultant Steve Rosenberg, was to reach consensus on a series of issues fundamental to financing school,based health centers.
...
-- Steve Rosenberg, Rosenberg & Associates

Is it possible, asked Rosenberg, for school,based health centers to avoid the undesirable but necessary choice that confronted community health centers in 1972?Will school,based health centers be forced to abandon their community,driven, social model of health care to secure a place within the current reimbursement system?Will we have to burn the village to save it?

The alternatives seem few.Consider this scenario offered by Rosenberg:

"Assuming the average cost of a comprehensive school,based health center serving a school with 1,000 students is $200,000, and all of the students are insured, the center would need a $16 per member/per month (pm/pm) rate to operate in a fully capitated environment."

Most panelists agreed that the market would not support such a rate.What, then, are the viable alternatives?

Rosenberg offered the possibility that the Omnibus Budget Reconciliation Act of 1995 might include provisions for a Medicaid block grant program, which could include a series of directives concerning use of Medicaid funds.One such directive might involve a federally mandated cost,based reimbursement (or carve out) for a defined transition period for community health centers and other federally qualified health centers (FQHCs).Rosenberg asked meeting participants if school,based health centers should be given the statutory right to be paid costs from all financing mechanisms -- as are FQHCs -- during this transition to full,blown managed care?Under such a scenario, school,based health centers essentially would operate as an independent system of care and would not be required to seek prior authorization when serving managed care patients.

The advantages of such an arrangement, according to Rosenberg, would be two,fold: 1) if the carve out were for a transitional period, that time could be used to establish a historical cost and data record, which is needed to create a managed care reimbursement rate structure; and 2) the carve out would give school,based health centers greater leeway in negotiating a role in their community's managed care systems.
...
Steve Rosenberg broadened that definition: "No gate keeping is a form of carve out.
...
But, Rosenberg warned, if school-based health centers refuse to play the federal reimbursement game, they will be left to rely primarily on local dollars.
...
The reluctance of school,based health centers to embrace cost,based reimburse-ment for their services reflects, according to Rosenberg, a conservative community.
...
Essential to the pursuit of these dollars, said Rosenberg, is the building of a political constituency sufficient to ensure a place at the bargaining table when difficult choices must be made about the division of diminishing local health dollars among community providers.
...
-- Steve Rosenberg, Rosenberg & Associates

How do you control for the Woodwork Phenomenon?, queried Steve Rosenberg.
...
The goal of the afternoon session, which was facilitated by health care finance consultant Steve Rosenberg, was to reach consensus on a series of issues fundamental to financing school­based health centers.
...
-- Steve Rosenberg, Rosenberg & Associates

Is it possible, asked Rosenberg, for school­based health centers to avoid the undesirable but necessary choice that confronted community health centers in 1972? Will school­based health centers be forced to abandon their community­driven, social model of health care to secure a place within the current reimbursement system? Will we have to burn the village to save it?

The alternatives seem few. Consider this scenario offered by Rosenberg:
...
Rosenberg offered the possibility that the Omnibus Budget Reconciliation Act of 1995 might include provisions for a Medicaid block grant program, which could include a series of directives concerning use of Medicaid funds. One such directive might involve a federally mandated cost­based reimbursement (or carve out) for a defined transition period for community health centers and other federally qualified health centers (FQHCs). Rosenberg asked meeting participants if school­based health centers should be given the statutory right to be paid costs from all financing mechanisms -- as are FQHCs -- during this transition to full­blown managed care? Under such a scenario, school­based health centers essentially would operate as an independent system of care and would not be required to seek prior authorization when serving managed care patients.

The advantages of such an arrangement, according to Rosenberg, would be two­fold: 1) if the carve out were for a transitional period, that time could be used to establish a historical cost and data record, which is needed to create a managed care reimbursement rate structure; and 2) the carve out would give school­based health centers greater leeway in negotiating a role in their community's managed care systems.
...
Steve Rosenberg broadened that definition: "No gate keeping is a form of carve out.
...
But, Rosenberg warned, if school-based health centers refuse to play the federal reimbursement game, they will be left to rely primarily on local dollars.
...
The reluctance of school­based health centers to embrace cost­based reimburse-ment for their services reflects, according to Rosenberg, a conservative community.
...
Essential to the pursuit of these dollars, said Rosenberg, is the building of a political constituency sufficient to ensure a place at the bargaining table when difficult choices must be made about the division of diminishing local health dollars among community providers.
...
-- Steve Rosenberg, Rosenberg & Associates