The recent opinion has been that managed care is quickly running out of places to squeeze costs; the easy savings are gone, and all that’s left is to nit-pick every last nickel.
This would mean that health insurance premiums would be on the rise at a much greater pace than they have been the last few years.
But managed care may have one area that hasn’t been fully tapped. A recent study by the Center for the Advancement of Health indicated that if behaviors were better managed, chronic diseases, disabilities and premature death rates could be reduced.
Nearly half of the nation’s premature deaths from the 10 leading causes of mortality are attributable to controllable behavioral factors such as unhealthy diet, lack of exercise, tobacco use, alcohol and drug abuse and risky sexual practices, according to the study. Behavioral risks are associated with higher ambulatory care and hospitalization costs, accounting for as much as 70 percent of all medical care spending.
Managed care can help control costs by incorporating programs that encourage healthy people and those with chronic illnesses to modify their behaviors to reduce health risks and maintain those behaviors over time.
Many health plans offer some sort of behavioral-change program, but they are often limited or applied in piecemeal fashion. Much of the effort is applied to helping patients manage chronic conditions rather than helping members reduce behavioral health risks.
According to the CAH report, available services consist primarily of pamphlets and brief, knowledge-based interventions, despite evidence indicating that educational strategies alone are not effective in producing sustained behavioral changes. Risk behavior programs also tend to be offered off-site, and usually involve additional costs for the person using them.
CAH recommends that managed care plans make use of public health strategies that identify people at risk, reach out to them, and match their needs and preferences for risk reduction and disease management with effective services that will make a difference. Such population-based strategies are not common practice within most health plans, even though most have in place the data and outreach capabilities that could be used to support them.
As a result, managed care has the tools in hand to start controlling behaviors that result in as much as 70 percent of its costs. If industry leaders can put together an effective program in the coming years, health care costs will remain stable for quite some time.
Todd Shryock ([email protected]) is SBN’s special reports editor.