Learning From The 90s Managed Care Organizations To Build Contemporary Value Based Organizations..

For patients and providers embroiled in an ever-changing and increasingly complex healthcare system, the term “Managed Care” has a negative connotation that seems like the enemy. From a patient perspective it implies rationing of healthcare and as a provider means lower reimbursement for their work. Managed Care was derived from a need to manage healthcare costs, utilization, and quality of care. We need to shift from traditional Managed Care to a more contemporary value based model which aligns patients, providers and payers.

MCOs became popular as a way of distribution for healthcare in the 1990s. They are commonly distributed in one of three ways: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), or Point-of-Sale Care (POS). The 1990s saw exponential growth in healthcare spending with the advent of MCOs. Thirty years later, we are seeing the long-term results of Managed Care on healthcare outcomes and the system as a whole. Studies are mixed on the healthcare outcomes that spring from a Managed Care system. 

To improve healthcare as a whole, Managed Care needs to be improved. There are several ways healthcare providers and people at the forefront of healthcare innovation can approach improving Managed Care:

• Improve Accessibility: During the pandemic, telehealth saw a considerable boost, improving accessibility of healthcare for many. This accessibility needs to continue, and coverage needs to be provided for telehealth services.
• Regulate Surprise Billing: In December of 2020, the No Surprises Act was signed into law. The act seeks to mitigate the surprise billing of patients. For healthcare to be effective for patients, they need to feel secure that billing practices are forthright.
• Less Red Tape: One of the hiccups inherent in Managed Care is all the hoops one must jump through to access care and have it covered. With physician shortages a present factor in the United States, patients also need clearer pathways to healthcare than what is currently offered in a Managed Care system.
• Competitive Pricing Structures: Healthcare organizations and providers need to coordinate with insurance companies on better pricing structures for patients for prescriptions and costs of care. 
• Build Strong Partnerships: Innovations in the healthcare space, such as what we bring to the table with Akos and LitonRX, depend on strong provider partnerships. Building relationships that bridge the gap between patient and provider takes time and effort. Still, any company entering healthcare today needs to make building those partnerships a crucial part of their business plan. Managed Care only works well if the relationships between providers, patients, and MCOs are strong. 
• Increase Access to Good Data: Anyone familiar with Managed Care will tell you that good Managed Care relies on sound data. With disruptive innovations happening regularly in the SaaS space, telemedicine, data collection, and data utilization, providers need to work hard to stay ahead of the technology curve. 

Managed Care remains the most common form of healthcare in the US. There are benefits to Managed Care that should not be overlooked:

• The instant access to healthcare that an MCO provides.
• Lower medical costs for those with healthcare plans.
• Easier prescription management.

However, no plan should be left to run unfettered, no matter the continued benefits. Healthcare is changing rapidly, especially concerning technology. The system and outcomes can be improved by analyzing the shortcomings of Managed Care and the shifting needs of patients.