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Related Experiment Videos

Assessing managed care's role in promoting preventive care.

M M Amonkar1, S Madhavan, S A Rosenbluth

  • 1Department of Pharmaceutical Systems and Policy, at West Virginia University School of Pharmacy, Morgantown 26506, USA.

Journal of Community Health
|June 27, 2000
PubMed
Summary

Managed care organizations (MCOs) can improve preventive care by implementing case management and utilization review programs. Targeted reminders effectively encourage members and providers to utilize preventive services for chronic disease management.

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Area of Science:

  • Health Services Research
  • Preventive Medicine
  • Healthcare Management

Background:

  • Managed health care systems are increasingly focused on preventive care for chronic disease management.
  • Assessing the role of managed care organizations (MCOs) in promoting preventive services is crucial.

Purpose of the Study:

  • To evaluate the effectiveness of various strategies and interventions used by MCOs to promote preventive care.
  • To identify MCO strategies and interventions that ensure appropriate utilization of preventive services.

Main Methods:

  • A national mail survey of 1,200 MCO directors involved in preventive care.
  • Data collection on perceived effectiveness, importance, and support for implementation of strategies like case management, utilization review, selective contracting, and cost sharing.

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  • Inquiry into interventions encouraging member utilization and provider offering of preventive services.

    • Main Results:

    • Case management and prospective/concurrent utilization review programs were rated highest in effectiveness, importance, and implementation support.
    • Cost sharing and retrospective utilization review programs received low ratings.
    • Telephone and mail reminders were effective for members; computer-generated reminders and medical record audits with feedback were effective for providers.

    Conclusions:

    • MCOs should prioritize case management and utilization review for enhancing preventive care.
    • Targeted communication strategies are effective for both patients and providers in increasing preventive service uptake.
    • Further research is needed to engage high-risk individuals who are not currently utilizing preventive services.