Redefining and Reaffirming Managed Care for the 21st Century

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The Issue

In their guest commentary for the 20th anniversary of the American Journal of Managed Care, The Commonwealth Fund’s David Blumenthal, M.D., and David Squires argue that the management of patient care, along with its policy and organizational underpinnings, has “deep intuitive resonance” with many people. But the term managed care still carries with it “paternalistic implications” that seem to “run crosswise of the emergent trend toward patient engagement in and control over the care experience.”

From Management to Engagement

Blumenthal and Squires call for a retooling of managed care to adapt to the shifting landscape in health care. They believe that process should begin with a review of the main domains of managed care:

  • Benefits management, which applies to managed care organizations that serve as both insurer and provider. Such organizations should use clinical benefits management to exclude or discourage services that are proven unsafe or ineffective. Financial incentives also can nudge patients toward the most effective services.
  • Clinical management, which involves using strategies that result in better-coordinated, high-value services. These include managing conditions between office visits, deploying patient registries and employing care teams, addressing nonmedical factors related to health, and applying shared decision-making. These techniques are likely to be easier and more successful when supported by an infrastructure that allows information-sharing and collaboration.
  • Patient engagement—critical for all patients, but particularly those with health problems. Health information technology can support engagement through online “portals” that allow patients to connect with providers remotely. Another strategy is improving transparency, by giving patients reliable information on quality and costs.

Conclusion

Despite the tension between the concepts of “care management” and “patient engagement,” managed care is still appealing to consumers and to clinicians who need tools to help manage patients’ chronic illnesses.

Read the commentary.

Publication Details

Publication Date: April 16, 2015
Authors: David Blumenthal, M.D., David Squires
Contact: David Blumenthal, M.D., President, The Commonwealth Fund
E-mail: db@cmwf.org
Summary Writer: Deborah Lorber
Citation:
D. Blumenthal and D. Squires, “Redefining and Reaffirming Managed Care for the 21st Century,” American Journal of Managed Care, published online April 15, 2015.
View the commentary

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