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Who's your best customer?

S MacStravic1

  • 1University of Colorado, Denver, USA.

Managed Care Quarterly
|February 1, 1999
PubMed
Summary
This summary is machine-generated.

Managed care plans should target high-risk individuals, not the healthiest, if effective health risk adjustment systems are implemented. This approach maximizes potential for improvement and fosters customer loyalty in healthcare markets.

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Area of Science:

  • Health economics
  • Healthcare management
  • Risk adjustment

Background:

  • Current managed care strategies often target healthy individuals.
  • Premium adjustment capabilities for individual health risks are limited.
  • This focus on healthy consumers is driven by inadequate risk adjustment mechanisms.

Purpose of the Study:

  • To challenge the conventional wisdom in managed care customer acquisition.
  • To propose an alternative targeting strategy based on risk and potential for improvement.
  • To explore the implications of improved health risk adjustment systems.

Main Methods:

  • Conceptual analysis of managed care market dynamics.
  • Economic modeling of risk adjustment and premium setting.

Related Experiment Videos

  • Evaluation of customer loyalty factors in healthcare.

    • Main Results:

    • The optimal target market for managed care shifts to high-risk, high-usage individuals under effective risk adjustment.
    • Healthy consumers offer limited potential for health improvement and retention.
    • High-risk individuals present greater opportunities for demonstrating value and building loyalty.

    Conclusions:

    • Implementing robust health risk adjustment systems is crucial for managed care efficiency.
    • Managed care organizations should re-evaluate targeting strategies to include high-risk populations.
    • Focusing on high-risk individuals can lead to improved health outcomes and stronger customer relationships.