Decades of change: Rocky Mountain CEO John Hopkins has witnessed managed care's evolution

In a sunny office in the dry valley between Salt Lake City and Denver, you'll find John Hopkins, the president and CEO of Rocky Mountain Health Plans. He has a 20-year history with the plan and has witnessed the ongoing changes in the nation's healthcare delivery system from Rocky Mountain's headquarters in Grand Junction, Colo. Few CEOs can claim such a tenure with a single plan, but Hopkins has never been anxious to leave an organization that remains solid despite healthcare's constant transformation.

Several somewhat parallel evolutions of managed care have occurred since its beginnings more than 20 years ago, according to Hopkins.

Patient-care-management changes over the past 20 years have led to reduced utilization and more individualized approaches that meet patient needs along the continuum of health status and delivery situations. No longer is the patient's health while under a hospital's roof the only opportunity for managing care.

"Early on, there was utilization management around hospitalizations," Hopkins says. "As time went on, we got involved in and recognized the value of doing some things in the outpatient setting, and that's when disease management started to come along, as well as case management. Those activities moved from the inpatient setting to the outpatient setting, and we recognized that we had opportunities there.

"There's always been the concept of population management, but these programs focused on specific patients," he continues. "It seems to me where we've moved now is focusing on chronic care and being able to affect the clinical treatment-the outcomes. The next thing we're moving on to-and in my mind this is all part of the evolution of managed care-is wellness."

Rocky Mountain, for example, created a comprehensive diabetes care model, which originally began as a pilot project in 2002. What's different about the model is the assertive hands-on approach with physicians to establish their role in the program. Physicians in the Mesa County Physician IPA received personalized training to create new care routines that would enhance outcomes for 2,000 Rocky Mountain members with diabetes.