The push towards outcome-driven health care, which intensified after the Affordable Care Act came into force five years ago, has prompted several managed care organizations to step up their efforts to deliver more value to members while keeping costs in check.
Among the more important shifts has been the emphasis on preventive medicine and services that can help identify and address health problems early, reducing the need for more costly treatments and interventions that can lead to long recovery periods and inconvenience patients. In fact, 80% of health plan executives say they are promoting value-based care through an increased focus on social determinants of health, including where people live and work. Their efforts include expanding outreach programs within their communities and some organizations have invested in medical vans to go around neighborhoods and provide services, like flu shots or blood pressure tests, for free, sometimes even to non-members.
Health plans have also begun partnering with providers in more formal ways, including establishing distinctly branded care access through joint venture partnerships with clinics and hospitals in more vulnerable communities where patients might not have previously had access to an insurance product.
Process Might Increase Liability
While outreach programs can be beneficial for patients, providers, and the overall health care system, a number of challenges must be addressed. Although liability risks — for example, bodily injury — are highly concerning, insurance coverage traditionally purchased by managed care organizations may not cover these new services.
Managed care entities that are expanding their services should consider the following actions:
Expanding services and increasing community outreach can provide value to patients, but managed care organizations must make sure they account for potentially greater risk, and ensure that their coverage addresses these new perils.