Building Public Health Goals into the Purchasing Process:: The Missouri Medicaid Agency As Purchaser

Introduction: As managed care radically changes the medical care environment, public health leaders are under increasing pressure to focus more on core public health functions and less on personal health services. As public health re-evaluates its key strategies, it can take advantage of its strategic role in purchasing medical care to forge new partnerships that benefit its constituents. Methods: Specific roles for public health in medical care purchasing are discussed. The state of Missouri is used as an example of successful strategies for positioning public health as a leader in the managed care environment. Key strategies include increasing influence in contracting; selecting and reporting of key health status indicators; promoting use of population-based data files; taking leadership roles in government-sponsored insurance programs; and assuring stability of critical health conditions during managed care transitions. Conclusion: Public health has unprecedented opportunities to develop new methods for improving health status. Public health’s well-developed scientific principles and methods, combined with strategic leadership, will position the discipline in the forefront of the dialogue about our nation’s health system into the next century.