Health Plans Need to Work Beyond Their Comfort Zones

John Marcille

There once was a time when doctors made house calls. Now, some are making calls on the homeless. Our cover story looks at some of the social determinants of health and begins with a decision to send a taxi to Grand Central Terminal in New York City to pick up a homeless woman and her disabled son.

That was the beginning of a remarkable comeback, as reported by Contributing Editor Joseph Burns.

Mother and child are doing much better. “That would not have been the case if we hadn’t taken care of all those other issues,” says William A. Gillespie, MD, CMO of EmblemHealth, a Medicaid managed care plan.

Those “other issues” — food, housing, and child support — are the reason, some experts argue, that 1% of Medicaid patients account for about 20% of all health care spending. Sweden spends 28% of its gross domestic product on social services and 10% of GDP on health care. The United States spends 20% of GDP on social services and 17% of GDP on health care. Yet the U.S. infant mortality rate is twice that of Sweden, and our maternal mortality rate is six times Sweden’s.

Connection or coincidence?

Our story on cancer centers also challenges health plans to do more. Too often, insurers focus on the oncologist’s practice and do not get around to managing the full scope of services.

Then, there’s mental health. This is a little trickier, without any overriding proof that insurer involvement will better outcomes and/or cut costs. But there are some government programs that you should keep an eye on.

This is a lot to ask, I know. If you need a break from all these tough problems, we offer one: health care cartoons, by one of this country’s best cartoonists.

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Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
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Our other journal

P&T Journal for October 2014

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Steady Progress on Parkinson’s Disease

DEPARTMENTS

MEDICATION ERRORS

Telling True Stories Is an ISMP Hallmark

PRESCRIPTION: WASHINGTON

FDA Accepts Its First Biosimilar Application

New Drugs/Drug News/New Medical Devices

Pharmaceutical Approval Update

DRUG FORECAST

Edoxaban: an Investigational Factor Xa Inhibitor


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