Managed Care 101 Primer
Managed care is not what it was meant to be. Even 20 years ago one of the structural engineers of managed care acknowledged a significant discrepancy between the real managed care world and the quality-driven, low cost health care system its inventors had envisioned. However despite its questionable track record, managed care appears to be here to stay, evolving to meet the growing demands of patient advocacy and consolidated provider stakeholders.
From its inception following the Health Maintenance Organization Act of 1973 to today, managed care has transformed healthcare from a not-for-profit service industry to a market-driven competitive landscape in the name of quality and cost management. Now the status quo across all channels, managed care is as much blamed for the uniquely expensive cost of care in the U.S. as it is criticized for its creation of utilization management techniques that could lead to withholding of necessary care. Meanwhile these techniques such as prior authorizations and specialty tiers led to the rapid growth of patient advocacy groups, a new and important stakeholder to consider in any healthcare strategy.
How do you wrap your head around something so entrenched in our healthcare system that even the industry-shaking Affordable Care Act left it largely intact? How do you segment–and leverage–the aspects of managed care that are designed to drive cost, quality, and outcomes? How do you understand–and leverage–the choices patients have regarding seeing specialists or access to treatments?
To understand managed care requires a deep understanding of politics, economics, and social welfare. Luckily we have taken our deep understanding and created research to support your working knowledge of managed care. Our Managed Care 101 Primer will walk you through the critical components of managed care and current examples of where and how it is (and is not) working to drive cost, quality, and outcomes.
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