The role of the geriatrician in managed care: opportunities and responsibilities

Managed care offers unique opportunities to the geriatrician. Geriatricians in managed care can facilitate the provision of high quality comprehensive care for older populations and do so within reasonable financial limits. With the financial incentives of Medicare Risk contracts, the geriatrician can ensure that care is not rationed inappropriately, nor is it overutilized. As pointed out by Boult in the article on systems of care for older populations, there are several creative possibilities for programs and clinical approaches that can take advantage of the systems in place in managed care. Managed care needs to emphasize integration of multiple programs that focus on the care of the chronically ill older adult and, at the same time, prevent the fragmentation of care that so often occurs in care delivery. With so many organizations merging and the level of complexity of healthcare systems becoming increasingly complex, programs directed specifically toward the older adult must be developed and maintained. Geriatricians must be in leadership positions to ensure this happens successfully. Possible roles for the geriatrician to undertake within a managed care organization and their potential time commitment are shown in Table 1. The assumption is that in most cases each position would not be full time and that the term half-day is defined as 3 to 4 hours in a week that is made up of 10 half-days.