MANAGED CARE April 2005. ©MediMedia USA
Big issues in managed care? Depends on where you are standing, does it not? If you are a physician or a hospital administrator, the issues are how many patients you have and how much you are paid for treating them. If you work at a health plan, it’s much the same — along with the problem of how much you have to pass on to the providers doing the actual work.
Or are you a public policy person — a senator or an advocate for a specific sector? Then you might be more interested in legislative and judicial issues. Employers, patients, and vendors all see things differently. Remember the blind men and the elephant.
It doesn’t get sustained publicity, but for employers and for a substantial number of patients and their families, substance abuse [1] is a big issue. Families are sundered; lives are destroyed (metaphorically, and sometimes literally); expenses are burdensome. Our cover story by Contributing Editor Martin Sipkoff looks at how employers and health plans more or less turned their back on this problem, but are now showing signs of renewed interest, including procedures for identifying abusers and treating them. He describes how complex this can get, what with the intersection of mental health and substance abuse, and what several vanguard plans are doing to increase their level of service.
For the patients involved and for the governments that pay, how managed care fits with Medicare and Medicaid is a hot topic right now. The Medicare Modernization Act of 2004 is promoting establishment and expansion of managed care plans [2] this year. Getting a plan started in a short time, however, is no mean feat. Meanwhile, plans are finding opportunities in the states’ Medicaid funding crisis [3].
The medical director trying to keep a lid on costs is directed to a study by a diverse group of researchers who delve into the cost of coronary restenosis in a managed care population [4].