Managed care redux: health plans shift responsibilities to consumers

Area of Science:

• Health Services Research
• Health Economics
• Managed Care

Background:

• Health plans face pressure to reduce double-digit premium increases while maintaining broad access to care.
• Employers seek to control rising healthcare costs and respond to employee demands for less restrictive managed care.
• A managed care backlash necessitates strategies that balance cost control with consumer satisfaction.

Purpose of the Study:

• To investigate how health plans are adapting to conflicting pressures of cost containment and access.
• To understand the strategies employed by health plans in collaboration with employers.
• To examine the evolving role of consumers in managing their healthcare finances and care.

Main Methods:

• Analysis of findings from site visits conducted by the Center for Studying Health System Change (HSC).
• Data collected during 2002-03 from 12 nationally representative communities.
• Qualitative assessment of health plan and employer strategies.

Main Results:

• Health plans are introducing products that transfer greater financial and care management responsibilities to consumers.
• These strategies are developed in partnership with employers aiming for premium control and employee satisfaction.
• Health plans are intensifying utilization management for high-cost services and focusing care management on high-cost patients.

Conclusions:

• The trend towards increased consumer engagement in healthcare is evident.
• The ultimate impact of these strategies on healthcare costs and consumer acceptance requires further observation.
• Future research should assess the long-term effectiveness and patient willingness to adopt these new responsibilities.