Best practices in women's health: identifying exemplary care. Hormone replacement and mid-life issues

Because health plans are organized systems of care providing comprehensive benefits with coordination and accountability, they can deliver care in a way that the old system could not. Health plans can track patients and patient groups and develop programs to increase the likelihood that patients receive preventive care, that chronic conditions are managed more effectively, and that various treatment approaches are monitored to track outcomes. None of these services were possible when individuals went to doctors and simply sent a bill to their insurance company for reimbursement. All over America, health plans are working to realize the potential of organized systems of care. In recent years, however, these efforts to improve care have been largely eclipsed by debates about the shortcomings--both real and perceived--of an evolving system of managed care. In 1996, The Commonwealth Fund provided a grant to the American Association of Health Plans (AAHP) to identify models of delivering care to women through health plans. The Fund views highlighting exemplary models as important to improving health care for women throughout the managed care industry. This article is part of a series based on that work, and is a follow-up to an article on hormone replacement therapy that appeared in the March/April 1999 issue of Healthplan (p. 65). Gleaned from more than 1,000 health plans across the country, this series showcases exemplary practices and programs in four women's health topics: breast cancer, domestic violence, obstetrics and prenatal care, and hormone replacement therapy and other mid-life issues.