Personalized Medical Care: The Carrier ’s Vision

For insurance carriers, relationships have historically focused on three key stakeholders: rate payers, brokers and clinicians. Commercial carriers have moved from being primarily fiduciary intermediaries to playing a more pivotal role in the health and lives of members. It is no longer sufficient to simply identify the best providers for the population, underwrite risk and pay for care. We have taken on new, innovative roles, including: Ensuring that evidence-based medicine is practiced. Providing guidance for managing the delivery system. Identifying gaps in care for members and their providers. Providing incentives to clinicians and hospitals for improving health outcomes. This transformation has been driven by the realization that health outcomes in the United States were not improving at the same pace as costs were rising.  It has become clear that we as Americans created the system that ate the economy! While these improvements have begun to move the needle on improved quality, better outcomes and slowing the rate of inflation, these improvements were still not meeting the needs of the population. Within the Medicaid program, these challenges have been even more acute. Managed Medicaid has significantly improved the cost of medical care for our most vulnerable citizens and has made key differences in outcomes.  At United, we’ve moved to a more comprehensive approach. We have: Expanded the role of call center representatives to an “advocate for me.” They not o...
Source: Society for Participatory Medicine - Category: Journals (General) Authors: Tags: Book Review Source Type: news