Managed Care

As the healthcare industry transforms on multiple levels, risks continue to emerge. The shift from fee-for-service to value-based care is pushing some services out of hospitals and into different care settings, such as clinics, ambulatory facilities, and telehealth appointments. Evolving regulations are creating uncertainty in health plans' payment responsibility. An explosion in healthcare data and patients' changing preferences are requiring plans to accelerate their technology investments and engage plan members through new channels, such as mobile apps.

Each of these developments is adding pressure to the business of managing care. Greater agility and risk resilience in this environment will separate successful health plans from the rest.

Our team of dedicated managed care advisors within our US HealthCare Practice has extensive experience in helping MCOs evaluate and mitigate their risks to develop the best possible risk management programs for MCOs' unique exposures.

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FAQs

Healthcare as an industry was quick to respond to COVID-19 and pivot away from traditional office appointments to the more progressive option of telehealth visits. For health plans, this meant quickly evaluating services to determine which were both telehealth appropriate and reimbursable. Now that health care consumers have had a taste of the convenience of doctors’ visits on a screen, MCOs will have to continually evaluate coverage options and pay schedules offered in their plans.

COVID-19 also increased America's conversations around mental health awareness and the need for access to quality mental health providers. MCOs will need to increase their in-network mental health benefits in order to meet member demand or risk losing subscribers to competing plans.

MCOs are subject to the same HIPAA regulations as providers; therefore, the safeguarding of protected health information (PHI) is paramount. With the level of personal information stored in patient data records, healthcare data remains a prized target of cybercriminals, and evolving attacks — such as ransomware — continue to wreak havoc. Thus, cyber risk management and resilience are critically important in healthcare. Another risk in managed care is not harnessing the volume of available health data, as this information serves as a guide to improve services and increase value.

Our team of risk specialists can help your organization balance the requirement to protect data privacy while preserving access to the data that drives your business.

MCOs should have robust risk management programs for the exposures they face. With a blurring of the lines between health plans and providers and greater use of technology and data, risks are growing. Some insurance solutions that can help managed care organizations like yours include:

Managed care errors and omissions liability
Cyber liability
Directors and officers (D&O) liability
Healthcare professional liability

Marsh’s healthcare risk specialists have experience and tools to help you better manage risks and focus on achieving your strategic objectives in a changing environment.

Managed Care