Although managed care has changed dramatically over the last 30 years, its essential value proposition is the same: deliver higher quality and lower costs compared with fee-for-service arrangements.
We refuse to accept a tradeoff between quality health outcomes and affordable care. Governments and taxpayers demand both. Patients deserve both. And it is a constant challenge to deliver both.
This year’s Managed Healthcare Executive State of the Industry Survey finds that nearly two-thirds (64%) of responding healthcare executives have made improving quality and lowering costs their organizations’ prime focus—but barely more than one in six (18%) think that healthcare quality and costs are improving. Nearly half (48%) believe that quality and costs are getting worse.
But managed care is up to the challenge. Our ‘secret ingredient’ is the ability to craft creative solutions to address quality and cost. Value-based payments are a big part of the equation; they align financial incentives in the direction of paying for health outcomes instead of encounters and procedures.
Social determinants initiatives contain cost, improve outcomes
However, health plans have been going even further upstream and working to address social determinants of health. In many ways, our health is the sum total of our lived experience—what we eat, where we live, and how we work all contribute. These social determinants often have a more profound influence on a person’s health than medical care itself. And unlike our genes, these social determinants of health are not set in stone. They respond to outside influences and incentives.