Providing Medical Management In Consumer-Directed Plans

John A. Marcille

You know the saying about giving someone a fish as opposed to teaching him to fish. Well, a lot of consumers are going to feel that the medical industry has told them to go fish, and forgot to include the lessons. Enter the health plan. Our cover story by Contributing Editor MargaretAnn Cross shows just what consumers are up against. As the story points out, presenting medical management as a benefit to members as opposed to something the health plan is doing to improve its bottom line may make consumers more accepting of the programs, reduce costs to the payer (the employer or government), and help plans to do their jobs better.

I was pleased and gratified to learn that far from abandoning the enrollee, current CDH plans seem to provide enough guidance to push the patient in the right direction. CDH plans are usually described as if they were basically old-fashioned indemnity coverage (deductible, catastrophic, “we’ll cover 80 percent”). Evidently, the terminology and the reality are not the same: CDH might not involve prepayment, as in an HMO, but it sure involves managing care.

In this issue, we also look at how hospitals, in a bizarre twist on what has historically been a tense relationship, may be able to talk most freely to health plans about quality improvement.

Our Q&A with Richard Stefanacci, DO, is a big heads-up on what to expect with Medicare Part D come Jan. 1, 2006. Namely, headaches.

We also take note of the potential growth market for retiree coverage and just what the marriage of genomics and predictive modeling means to care and coverage.

There’s also a quick look at how one entrepreneurial spirit is offering to manage (at a cost) an expense that’s growing: durable medical equipment.

Lots of information to help shore up the bottom line. Now, if that’s not teaching someone how to fish….

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