Assessing managed care's role in promoting preventive care.
The current trend of managed health care systems opens the door to more effective control of chronic diseases through preventive care. The goal of this study was to assess managed care's role in promoting preventive care. A mail survey was conducted of a national sample of 1,200 directors, associated with preventive care, in managed care organizations (MCOs) in the U.S. Data was obtained on perceived effectiveness, degree of importance, and likelihood of support for implementation of strategies recommended (case management, utilization review programs, selective contracting, and cost sharing) for ensuring appropriate utilization of preventive services. Also, information was collected on interventions perceived effective in encouraging plan members to utilize and providers to offer preventive services. Response rate was 17.3%. Case management and prospective and concurrent utilization review programs were perceived most effective, important, and likely to receive support for implementation while cost sharing (using deductibles and coinsurance) and retrospective utilization review programs ranked low on all dimensions. Plan member-directed interventions perceived effective in encouraging utilization of preventive services included telephone and mail reminders while computer-generated reminders and medical record audits with feedback were perceived effective in encouraging providers to offer such services. Results identified preferred MCO strategies and interventions for ensuring appropriate utilization of preventive services. Further research is needed to develop methods to encourage people at high risk for chronic diseases not currently utilizing preventive services to receive such services.
Amonkar
M M
MM
Department of Pharmaceutical Systems and Policy, at West Virginia University School of Pharmacy, Morgantown 26506, USA.
Madhavan
S
S
Rosenbluth
S A
SA
Odedina
F T
FT
Simon
K J
KJ
D019090:Case Management / Q000191:economics / Q000592:standards; D003284:Contract Services / Q000191:economics / Q000592:standards; D017047:Cost Sharing / Q000191:economics / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D016730:Program Development; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014481:United States; D014600:Utilization Review / Q000191:economics / Q000592:standards