New president new path forward for managed care plans


In the aftermath of the presidential election, health policy experts have less to go on than they have after any election in memory.

The November election sent conventional wisdom for a long walk in the woods. In its aftermath, health policy experts seeking clues about what the election portends for healthcare have less to go on than they have after any election in memory.

The Trump healthcare platform was short on specifics, and the president-elect and his circle of advisers issued conflicting statements about their plans for health policy both during the campaign and in the days since the election.

Regardless of the specific path Congress and the administration take upon assuming office in early 2017, there is one piece of conventional wisdom you can take to the bank: Publicly-financed health coverage programs are going to be looked at closely by leaders on Capitol Hill with an eye toward spending cuts and programmatic reform.

Block grants and per-capita allotments are on the table for Medicaid, and Speaker Ryan has discussed advancing the idea of doing away with traditional Medicare in favor of a premium-support plan.

One thing is common to most of the reform proposals being discussed: managed care figures prominently.

As lawmakers consider how to reform public health coverage programs, the one thing that managed care executives can do to inform the debate is provide clear, actionable information that helps Congress and agency staff understand the import of the decisions they have to make in the months ahead. One item for all managed care executives across all lines of coverage business is the development and refinement of a clear value proposition that lawmakers can understand.

Many members of Congress already understand that the concept of “value” extends beyond the price tag attached to public health coverage. Especially in managed care, the idea is that we’re delivering health-which is sometimes but not always health care. And that’s where the value lies.

One way, for instance, in which Association for Community Affiliated Plans (ACAP)-member Safety Net Health Plans deliver on value is through addressing the underlying social determinants of health, which can have an outsized influence on the health of people with low incomes.

Some plans have found that simply providing housing to people with unstable living situations and multiple chronic conditions can lead to cost savings and better health outcomes.

One plan, UPMC for You, has had success through its Cultivating Health for Success program. By providing housing to patients with high levels of medical need and unstable housing, they managed to reduce medical costs in a way that led to net savings.

This is just one example of demonstrating how managed care can improve health and save money-even if that money is directed at areas outside the traditional healthcare system.

Managed care is at a further advantage in that the Healthcare Effectiveness Data and Information Set (HEDIS) is a clear way to draw lines around the value a plan can deliver. It’s a simple shorthand that lawmakers, regulators, benefits managers and others can consider when setting quality goals or selecting plans during a procurement.

Whether it’s quality metrics through HEDIS, medical loss ratio data or other ways of delivering value-such as addressing social determinants or effectively curbing abuse of opioid painkillers-it’s clear that the delivery of clear, unbiased information is one way to help the incoming Congress and Administration effectively reform public coverage programs in a way that doesn’t adversely affect the millions of people those programs serve.

Margaret Murray is CEO, Association for Community Affiliated Plans.


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