What’s Managed In Managed Care. Part 1


Most people these days have been exposed to managed care, and yet don’t understand what it means or what is managed. The majority think managed care is synonymous with either managed cost or HMO. In fact, there are some similarities and some differences.

It would be very different if managed care had been named care management, which more closely describes what we have today. True, to begin the change in delivery systems, cost was the driving force. However, since that time many checks and balances have been introduced making cost only one aspect of management. Hopefully, all the pieces now fit together to deliver health care which is perceived as a value.

Quality improvement has been present for many years in the industrial segment of our economy and recently made the transition to health care. Through quality assurance, we have been able to review and assess the delivery of health services. By setting standards, reviewing and changing as necessary, and adding value to those procedures which work well, we have been able to create improved patient satisfaction. When this occurs, it may be said that we have delivered a better service than before. Isn’t that what it is all about?

Patient satisfaction is but one measurement of outcomes. Some other things we can measure are mortality, morbidity, and health status. But since medicine is an art and not a science, we are just beginning to develop the capability to measure these. Through outcome management, we will be able to measure things which have not been measurable before. You might say that these measurements are outcomes of managed care.

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