Question

Describe the role of managed care in health promotion and disease prevention.

Answer 1

Managed care offers great opportunities for the improvement of public health in our country. Population health can be improved by the structured format an MCO imposes on the delivery of health care services, which is better than the fragmented way in which health services are delivered in other contexts. MCOs can also provide databases for public health surveillance and evaluation purposes, in order to better determine the real health care problems facing the nation.

The major premise of managed care plans has been to save money for the plan by keeping its members healthy. MCOs usually focus their efforts on population-based medicine, attempting to achieve desired outcomes that include prevention activities. Managed care organizations of the 1980s and 1990s were interested in applying insurance coverage to health services that provided disease prevention and health education for their subscribers. Since most of the U.S. population receives health services through managed care, these organizations have a tremendous opportunity to affect the incidence and management of infectious disease. This form of prevention involves the concept of population-based medicine. Disease prevention offers an answer to the cost escalation of health care and the less than adequate health outcomes being produced by our health care system today.

Preventive medicine offers a challenge to the traditional model of health care delivery. Traditional focus of the U.S. health care delivery system has been reactive, providing services to patients only when they became symptomatic. In recent years this delivery system has slowly begun to better understand the value of proactive health care delivery and to act on that idea by seeing patients for well visits in order to prevent disease through helping them reduce high-risk health behaviors.

Managed care organizations offer a tremendous opportunity for improvement in the prevention and management of disease. An MCO provides services to a defined population and it has up-to-date information about this population. It can provide health promotion and it is able to make comprehensive changes in care. In many instances the MCO could resemble a public health department by delivering population-based medicine and encouraging its members to use preventive health care services.

Managed care and public health departments are both involved in providing health care services to a population. This makes them interested in the health of the population and interested in interventions that might prove able to improve the health of an entire community. Both are interested in the expansion of health education programs for the young and the old and the targeted reduction of high-risk health behaviors throughout the community. In fact many managed care plans employ the services of epidemiologists to better track the incidence and prevalence of disease in the geographic areas they cover. These health plans also have the resources necessary to develop, implement, and even more important, evaluate the successes and failures of disease prevention activities in a given community.