Everything Old is New Again: Reinventing Managed Care

We all hold on to that favorite tie or dress with the hopes that it will eventually come back into style. The implementation of the Affordable Care Act (ACA) is the health care equivalent to the resurgence of the forgotten mini-skirt…except the item being pulled out of the closet is “managed care.” It was not too long ago that consumers vilified HMOs and the idea of a primary care doctor acting as a health care gatekeeper was disdained. Now, all that is changing. Why, you might ask? Consumerism! Now that consumers are paying more out of their pockets for their health care, suddenly everything they abhorred about the old managed care system and efforts to contain costs are now a lot more appealing.

One of the major drivers in consumers’ newfound interest in managing costs has come from the emergence of high deductible plans. While the premiums can be relatively affordable, they have high deductibles, co-pays and co-insurance. In 2014, 65% of people who enrolled in the public exchanges chose silver plans, which cover 70% of health care costs and have average deductibles of $2,927 for individuals and $6,010 for families. In other words, now that more consumers have skin in the game, their expectations for how health care providers manage and communicate their costs are changing.

Let’s look at a few examples of how health plans, hospitals, pharmacies and doctors are innovating to better manage costs and meet patient demands for convenience, affordability and value:

  • Until very recently, most patients would not dare to ask how much a procedure or visit would cost. Now, it is expected. In response, health plans are now offering cost calculators and apps where their members can choose a physician or procedure based on a variety of factors, including price. Priority Health has teamed up with their hospital partner, Spectrum Health to develop a transparency tool that discloses price and fee information for over 300 services.
  • Health Grades is another popular tool consumers are using to learn about quality rankings and consumer reviews of hospitals and doctors.
  • Retail “Minute Clinics” are popping up everywhere to appeal to consumers who are increasingly time-pressed and like the convenience of a neighborhood clinic. These clinics also publish their fees, so it helps the consumer manage their costs. At Walgreen’s Healthcare Clinic, you can see a Physician Assistant for colds, vaccines, physicals, health screenings and help managing chronic conditions. The Walgreen’s Pharmacy will review your medications and can even administer blood-screening tests all at published prices.
  • Remember house calls? For those who need access to a physician 24/7, or have an emergency in the middle of the night, virtual physician visits via video chat or phone are growing in use. The American Telemedicine Association estimates that as many as 500,000 patients will see a doctor via webcam this year. Hospitals are also using telemedicine to manage chronic conditions and even care for patients at home. With the average cost for daily hospital care at $4,500 per day, it is no wonder that hospitals and patients alike are looking for ways to reduce those costs. Technology now exists that can provide continuous monitoring of vital signs at home. Many hospitals are now building the technology infrastructure to collect at-home patient data so that they can care for more patients while they remain at home. 1
  • Physicians are also recognizing the importance of factoring value into clinical decisions. The American Board of Internal Medicine Foundation has developed an initiative called “Choosing Wisely,” which is intended to foster conversations between physicians and patients about appropriate care and to convey that more care isn’t always better care.

While it will take time for many of these new innovations to gain mainstream adoption, it is encouraging that so many health care providers are responding to patient consumerism and planning ahead to serve their patients more effectively and help them make wise spending choices with their limited health care dollars.

Photo Credit: Flickr’s Taber Andrew Bain

  1. Matt McMillan. E –Doctors: Virtual visits give patients options. WebMD Health News. October 10, 2014

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