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Crossing Old With New

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Health plan designers are starting to pollinate traditional managed care plans with consumer-driven health care concepts.

The result is a new breed of hybrid health plan that combines the strengths of traditional managed care plans and consumer-driven health plans.

Theoreticians may quibble about how to classify a health plan, but for employers and their benefits advisors the key question is a simple one: “How well will this health plan use technology and financial incentives to deliver the best possible health care at the lowest possible cost?”

Traditional managed care companies did a great job of identifying high-quality providers and encouraging plan members to get basic preventive care. But the companies also created a generation of consumers who think an office visit really costs $15.

Managed care companies have responded to competition from consumer-driven health plans by adjusting the original consumer-oriented financial incentivesoverall co-payments and coinsurance ratesto give employees more “skin” in the game.

In addition to adjusting traditional cost-sharing mechanisms, the new hybrid plans also are adopting strategies such as varying provider pricing. A hybrid plan might, for example, use lower co-payments to steer patients toward a less expensive “tier” of in-network hospitals.

The new hybrid plans also are adding new “pay for performance” incentives for providers, to encourage providers to reduce the cost of caring for the 20% of patients who generate 80% of the claims.

Just as technology has helped consumer-driven health plans administer personal health accounts, technology is helping the new hybrid plans administer variable provider pricing programs, pay-for-performance programs, and even basic co-payment and coinsurance programs.

is president of Meridian Health Care Management Inc., Woodland Hills, Calif., a managed care management services organization. He can be reached at [email protected].

Reproduced from National Underwriter Edition, April 15, 2005. Copyright 2005 by The National Underwriter Company in the serial publication. All rights reserved.Copyright in this article as an independent work may be held by the author.


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