From Fierce Health Plan
The fragmented array of care many Americans currently receive results in widely varying prices and outcomes, writes Jon Kaplan, a senior partner at the Boston Consulting Group. Furthermore, the fee-for-service model fails to control rising costs because it doesn’t focus on improving patients’ health.
But the companies that pay for healthcare have discovered a better way with the Medicare Advantage program, which uses preferred provider networks, financial incentives and care management to lower costs and keep patients out of the hospital, Kaplan writes.
Indeed, Medicare Advantage may be a more powerful tool than even Meaningful Use to power healthcare reform, NaviNet CEO Frank Ingari has written previously.
And when Kaplan’s company evaluated claims data for 3 million Medicare patients in 2013, it found that patients in managed care programs such as a capitated HMO plan achieved better outcomes than their fee-for-service counterparts, including lower mortality rates, fewer hospital admissions and shorter hospital stays.
The country’s major insurers have learned from these results, Kaplan argues, and continue to develop better care models to keep costs low. That’s why the coming mergers are a good sign, as they would lend greater scale and market power to these companies’ expertise in managed care.
So the question is, do you want your health care “managed” by an insurance company or health care management company? The President in 2009 repeatedly said no one should come between you and your doctor; he was referring to insurance companies.
What exactly is the role of an insurer when it comes to the health care you receive or your health for that matter?
How do you define managed care? Do you believe that doctors who participate in your insurance plan, are managed?
Do you want your choice of doctor or health care facility limited?
Do you feel there is a difference between coordinating your health care and managing it?
QUINNSCOMMENTARY 
You ask interesting questions. After having my health insurance company call me twice within a week inviting me to “share” my health issues and concerns with them, I not so patiently explained to the person on the other end of the phone, who claimed to be a nurse, that I hire doctors to see to my health, and I hire the insurance company to pay my doctors. I refused to “share” my health issues and concerns with a faceless, nameless bureaucrat (care-oh-crat?) . The plan I’m in allows me to stiff arm their entreaties. Naturally, laws governing privacy of health information also come into play.
I am intrigued by the study you quoted that claimed that patients in “managed systems” had better “outcomes” than the fee for service model. The question which remains begging of course is do people who already enjoy good health tend to enroll in managed care systems to begin with, and those who have, or suspect they will have, major health issues prefer the fee-for service model? (Shorthand: Uh, yeah, managed care does tend to work well for the healthy. )
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