Back to the drawing board: new directions in health plans' care management strategies.
The backlash against managed care has pressured health plans to reexamine their approaches to controlling utilization and managing their members' health care needs, but how much has really changed? Interviews with health plans and others in twelve nationally representative markets suggest that the changes are significant. New and refined disease management programs are improving the care experience of participants with certain prevalent chronic illnesses, while utilization management changes are reducing the administrative burden for providers. Still, disease management programs will need to greatly expand in scope and scale if plans are to succeed in addressing the complex health care needs of aging populations and those with chronic diseases.
Felt-Lisk
Suzanne
S
Mathematica Policy Research, Inc., Washington, DC, USA.
Mays
Glen P
GP
D002908:Chronic Disease; D003211:Concurrent Review / Q000458:organization & administration; D019468:Disease Management; D004465:Economic Competition; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D014600:Utilization Review / Q000458:organization & administration*