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Population-based chronic care and adverse risk selection: resolving the conflict.
The Quality Letter for Healthcare Leaders
|January 7, 1998
Summary
Managed care improves chronic illness management but increases health plan costs. Integrating insurer risk management with provider care management can optimize patient outcomes and control expenses.
Area of Science:
- Health Services Research
- Healthcare Management
- Public Health
Background:
- Managed care strategies aim to control healthcare costs and improve patient outcomes.
- Effective management of chronically ill populations presents unique challenges for healthcare systems.
- Current approaches may lead to increased financial burdens on health plans despite improved patient care.
Purpose of the Study:
- To explore a novel approach for managing chronically ill patients within managed care frameworks.
- To identify strategies for balancing improved patient care with cost-effectiveness for health plans.
- To propose a collaborative model integrating diverse healthcare management expertise.
Main Methods:
- Conceptual analysis of existing managed care models.
- Review of risk management principles employed by insurers.
- Examination of care management techniques utilized by healthcare providers.
- Synthesis of best practices from both insurance and provider perspectives.
Main Results:
- Managed care prevention techniques can enhance the care of chronically ill individuals.
- These techniques may concurrently elevate costs for health plans.
- A blended approach combining insurer risk management and provider care management is proposed.
Conclusions:
- Integrating the risk management expertise of insurers with the care management skills of providers offers a synergistic solution.
- This collaborative model has the potential to optimize the care of chronically ill populations.
- Such integration may lead to more efficient and effective healthcare delivery for vulnerable patient groups.