Managed care often feels like a taboo subject within the healthcare industry. Why? Because traditional managed care failed. Through HMOs and PPOs, it promised to improve outcomes and decrease costs. It failed to do either.
Improved outcomes and decreased costs benefit everyone. We just need a new approach.
But why did the old system fail? And why is care coordination the reboot we need to fulfill the promises managed care never could?
The Old Model: Managed Care
Traditional managed care attempted to control costs by keeping patients away from more expensive forms of care, like the hospital, the ER, and urgent care. Focusing on primary care, and using a network of preferred providers.
So when a patient needed to see a specialist, to save costs, their provider would refer them to someone in-network. But the cost savings never happened. It didn’t work. Tom Stoeckle, Director, Compensation and Benefits at Seattle Children's, explains why. “The model failed because there was no focus on behavior change.”
This type of control, all in the name of cost savings, was little more than a Band-Aid fix. And it could never address the root cause of people’s bad health, poor lifestyle choices. In fact, it actually prevented people from getting the care they needed, when they needed it because of:
Most patients ended up frustrated and unhealthy, with nothing more than a prescription to solve their problems.
The New Model: Coordinated Care
Managed care’s reboot is coordinated care. Like traditional managed care, coordinated care focuses on primary care as a patient’s main source of healthcare. But it goes beyond managed care by targeting the root problems of health, like poor access and a lack of behavior change.
An on- or near-site clinic delivers on the promises of managed care. But it's backed with the potential power of the coordinated care model.
Here are a few ways that an on-site clinic delivers coordinated care.
Benefits Plan Integration
Through an on-site clinic model, there are more opportunities for coordinating care because it fully integrates into an organization’s benefit strategy. With this information, providers can refer to specialists in-network that are high-quality and low-cost, which reduces costs for employees and employers.
Integrated Health Coaching
Health coaches, providers, and medical staff at an on-site clinic are trained in behavior change practices to help them empower patients to take ownership of their health. Patients are also given longer appointment times with providers and health coaches.
Instead of only having time to dole out a prescription, patients and providers have the opportunity to form meaningful connections and develop personalized care plans that address the root causes of the patients health issues. This approach is especially beneficial for patients with chronic conditions, like diabetes, because those chronic conditions are best mitigated by making positive lifestyle choices.