Good old reliable (?) trend forecasting should be re-evaluated.
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Biomedical subjects
Publications and source records attributed to Scott MacStravic.
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Two interrelated problems are included among the causes of managed care woes: the dramatic increase in unhealthy lifestyles together with the results these have had on health services utilization and expenditures; and the dramatic increase in consumer demand for "lifestyle" or quality of life (QoL) enhancing products and services. Together these are helping to drive managed care toward a crisis, in both commercial and government-sponsored insurance survival prospects. Aside from the frequently mentioned problem of our aging population and the shifting balance between the number of healthy young workers paying in, vs. unhealthy or older workers spending out, these problems greatly exacerbate the double-digit inflation that has become a recurring characteristic of health insurance premiums, and threaten the very existence of managed care.
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These new "health plans" are personalized, consumer-specific action plans created partially by and individually for consumers. They are aimed at improving consumers' overall health, reducing their risks for expensive and life-diminishing diseases, improving their self-management of chronic conditions they already have, and generally improving their quality of life, insofar as broadly defined "health improvement" will achieve that. This new form of "health plan" has been adopted by one of the major proponents of prospective health, Duke University Health System in Durham, NC.
Like all organizations, health plans have the choice of investing in efforts that will reduce their costs, or enhance their revenues. Clearly adding benefits to consumer members, particularly those who are so healthy that they currently use little health care, hence derive little value from membership, beyond the security of coverage, would promote retention of the most valuable members health plans have. While this may not pay off as immediately and directly to the bottom line as do cost-cutting measures, it may have far greater long-term value. Only by testing its potential and discovering the member retention and revenue-adding returns from such efforts, can plans learn how great this value can be.
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Although health insurance has traditionally been a cost center for employers, and they are ever striving to reduce such costs, MCOs have the opportunity to become a means for employers to save costs rather then suffer more. By focusing on the total health-related costs affecting businesses' bottom lines, MCOs can become "account managers, " where the "account" reflects all the costs that they can positively affect through their own initiatives, and thereby become true solutions rather than costs. This method will enable them to differentiate themselves from competitors and generate "solution pricing"-based new revenue focusing on outcomes versus coverage. This article covers the rationale for and basics of such a strategy.
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