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Managed care's health kick (National Managed Health Care Congress)

Spurred by their corporate customers, health plans are getting more involved with the day-to-day wellness of their members.

By Jonathan G. Bethely, amednews staff. June 19, 2006.

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Reports from conferences important to physicians

In the bad old days of HMOs -- still ongoing in many places -- health plans stepped in the middle of medical decisions by declaring what they would and would not pay for. Now in the coming age of consumer-directed health care, employers and others are asking health plans to step in the middle of medical decisions in another way -- by declaring to patients what health decisions they should and should not make.

In a way, what plans are being asked to do is what they said they would do at the dawn of managed care: actually manage care by worrying more about the health and welfare of members and less about nickel-and-diming on cost.

But nickels and dimes -- lots of them -- are steering health plans toward this adjusted role. That's because employers, especially small employers finding the cost of health insurance to be out of reach, are pressing plans to find ways to lower their insurance costs by making their employees healthier, and thus less likely to use their insurance. And with employees increasingly on the hook for medical bills -- between rising insurance rates and higher-deductible health plans -- employers think plans will have a willing audience.

The changing role of health plans was one of many topics related to consumer-directed health care under discussion at May's National Managed Health Care Congress in Washington, D.C., an annual meeting of health plans, businesses, government representatives and others.

At the meeting, plans talked about how they're already adjusting to the demands of employers and consumers by increasing their use of programs such as disease management.