Last Updated 15 Apr 2020

The Relationship Between Managed Care And Prevention

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In the fast and extensive changes that come with the evolving health-care systems in the United States, Managed Care organizations are viewed as the new actors in disease prevention and management. There are several reasons why Managed Care organizations should and are involved in disease prevention and management. First, managed care organizations have become the primary source of health care both for beneficiaries of publicly and employer-funded health programs such as Medicare and Medicaid.

Statistics show that Managed Care enrollment has jumped from 6 million people in 1976 to 51 million in 1994 (Bektas, 2000). Since Managed Care plans are basically set up as health care insurance policies, this rapid increase that is prevalent even in the present means a greater risk of financial loss due to members getting sick with all kinds of disease. It thus becomes an imperative for Managed Care organizations to provide programs for disease prevention and management in order to minimize potential loss. Second, Managed Care plans have historically included prevention.

This is embedded in the system’s performance measure as such organizations maintain and develop systems that aim to improve service quality. Thus, a god number of Managed Care organizations use internal performance-measurement and quality-improvement systems like Continuous Quality Improvement (CQI) for system oversight and enhancement. Since the primary goal of Managed Care organizations is the health welfare of its clients, it falls incumbent upon them to provide measures for disease management and prevention (Bektas, 2000).

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Previous preventive measures that Managed Care organizations were involved with include vaccinations, cancer and cholesterol screening, mammography, retina exams for diabetics and prenatal care. Third, since Managed Care organizations are basically representatives of organized care systems, they should take due responsibility for the populations they service. They are accountable to plan purchasers and individual consumers as well as to federal and state regulatory agencies for outcomes desired of all stakeholders which includes disease prevention.

The following are the current measures that Managed Care organizations provide for disease prevention and management. Diseases and Health Care Information Drives Information drives aim to use public awareness to prevent possible undesirable outcomes from occurring. This activity involves tie-ups with business and government institutions where the drives could be launched. Some information drives are launched in public schools while others are held in business districts or company buildings.

For its part, The Group Health Cooperative of Puget Sound (GHCPS), a Managed Care organization with 486,000 members in Washington and Idaho continues to have information drives on the dangers of smoking, depression detection and management, stress management, and bicycle safety tips for children (Gordon, 2003). Such moves have led to an 8% decrease in smoking prevalence from 1985 to 1994, a 44% increase in the use of proper bicycle safety gear among children from 1987 to 1992 which is cited as the main reason for the 67% decrease in bicycle-related injuries in the same period (Gordon, 2003).

Disease Screening Disease screening involves offering free services for routine examinations for common diseases. GHCPS has been involved with launching breast cancer screening programs in the past 12 years and continues to be involved at the present. The programs have yielded a 32% decrease in late-stage breast cancer. This is primarily because the program was able to detect breast cancer in early stages. This led to a 27% increase in survivability of breast cancer patients (Gordon, 2003).

United Health plan in Los Angeles is also funding a similar program, they have also included lung and skin cancer screening as well as cholesterol and sugar level monitoring. United Health has reported positive results regarding these disease screening programs. They determine several cases of abnormal cholesterol and sugar levels on a daily basis which help clients avoid further health risks. Immunization Programs Immunization programs require the procurement, delivery, and administration of necessary vaccines in order to prevent common diseases.

These often necessitate tie-ups with pharmaceutical companies and local government. The GHPCS, United Health, and several other Managed Care organizations continually launch immunization programs for childhood and adult vaccinations. The vaccines are for diseases like chicken pox, influenza, hepatitis, typhoid, mumps and measles. Similarly, the National Immunization Program has formed tie ups with several Managed Care organizations to improve preschool children’s vaccination status. The dynamics of this alliance have individual organizations working with public health agencies in conducting CQI initiatives in immunization areas.

The main objective is to increase vaccination rates in children up to 24 months of age. The program involves data collection and patient database management, parent education and incentives, and partnerships with both public and private entities for community outreach and immunization education. Implementation of the program over a 5-year period resulted to the standardization of vaccination records, various information seminars for medical staffs and children’s parents, and a vaccination completion rate that increased to 73% from 55% since the start of the program (Gordon, 2003).

Satisfied with the program’s initial success, the National Immunization Program continues its partnership with Managed Care organizations at the present. Breastfeeding Seminars and Pre-natal care Previous studies have shown that breastfeeding significantly increases infant’s immune system and body resistance. This is why United Health also implements a breastfeeding awareness and seminar program that seeks to make women who have just given birth or are currently pregnant aware of the advantages of breastfeeding their babies up to two years of age.

These seminars also discuss and disprove common misconceptions about breastfeeding and include illustrations on proper breastfeeding in order to minimize discomforts and maximize milk output. These programs have helped increase the prevalence of breastfeeding from only 7% in 1988 to 30% in 1990. Currently, breastfeeding programs have collectively encouraged 65% of American pregnant women to breastfeed for at least 6 months after giving birth (Gordon, 2003). Public Service Clinics

Public service clinics are situated in key locations within the coverage area of designated Managed Care organizations. Their primary task is to service the immediate community’s basic health care needs. Their objectives include preventing disease outbreaks, providing a venue for other programs such as screening and immunization drives, and administering immediate remedies regardless of health care insurance status. Of the 100,000 people under United Health’s public service clinics, only 65% are Medicaid or Medicare beneficiaries (Gordon, 2003).

Conclusion Managed Care organizations have genuine, industry based concern regarding the immediate and long-term disease prevention and management status of the areas that they operate in. This has led them to venturing into a variety of action plans that include information drives, screening and immunization programs, health awareness seminars and public service clinics. These projects show that managed Care organizations are standing up to their responsibility of not merely insuring but also ensuring the health of the American society.

References:

Gordon, K. (2003). Corporate Responsibility in Managed Care Providers. Howard & Sons: New Jersey.

Bektas, Y. (2000). An Analysis of Trends in American Health Care since World War II. Prentice Hall.

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