Lessons learned in managed care.
Competition, reduction in health care premiums, rising health care costs, aging of the population, and technologic advances are several factors that create both challenges and opportunities for managed care organizations (MCOs). The demands to constantly improve quality of care and efficiency of operation while holding down costs are drivers meant to stimulate organizations to constantly strive to rethink their process of care provision. The most cost-effective program is one that maintains its health plan members who are active in the community and away from the institutional setting. This is optimally achieved through an accessible and comprehensive ambulatory practice. Innovation and paradigms of practice change in the acute, subacute, and long-term care arenas have allowed us to dramatically impact quality and utilization in these expensive areas, while at the same time freeing up additional time for MCO primary care practitioners to focus on their community-based patients. MCO primary care providers have not only supported but welcomed these changes in their organization, recognizing that these innovations represent a component of the continuum of health care needed to effectively serve their patients.
Burl
J B
JB
Fallon Health Care System, Worcester, MA, USA.
D000368:Aged; D002204:Capitation Fee; D019090:Case Management; D003363:Cost Control; D017598:Efficiency, Organizational; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D006293:Health Promotion; D006801:Humans; D008404:Massachusetts; D006278:Medicare / Q000458:organization & administration*; D011367:Professional Staff Committees; D011785:Quality Assurance, Health Care; D019467:Subacute Care / Q000458:organization & administration; D014481:United States; D014600:Utilization Review / Q000458:organization & administration*