Show #404 Airing Sunday, 10/21/07
Managed care has managed to get bad press. Many folks see its focus as being on money rather than medicine. Is this true? Today I'm going to ask this question to Ronald Copeland, president and executive medical director of the Ohio Permanente Medical Group.
Question: What is managed care?
Answer: Most of your viewers probably grew up with and are most familiar with traditional health care that uses the "pains, claims and administering benefits" approach focusing on episodic care.
In managed care, the idea is to step back from the traditional model and engage physicians and the insurer to work collaboratively to manage the patient's total health. Managed care focuses on prevention and managing your health (immunizations, screenings), as well as offering treatment for acute illnesses (appendicitis, cold treatment) and chronic disease (heart disease, diabetes, depression).
Question: Does managed care mean that insurance bureaucrats instead of doctors make decisions about health care and treatment?
Answer: As traditional insurance companies entered the managed care arena, many adopted approaches used in manufacturing and other businesses to improve productivity while controlling costs. The problem was that the dynamics are totally different when dealing with human lives as opposed to manufacturing a product. Inevitably, barriers and conflicts arose placing some insurance companies at odds with the way physicians and their patients wanted care delivered.
Question: Why is Kaiser Permanente different?
Answer: Kaiser created the managed care model focused on helping people achieve the best possible health status. It was founded 60 years ago when Dr. Sidney Garfield worked together with industrialist Henry Kaiser to develop a health care system for Mr. Kaiser's employees who were working to build the Hoover Dam.
Dr. Garfield integrated several concepts together:
- Pre-payment. Instead of paying for each episode of care, patients pre-paid a premium, which then covered all their care. As a result, doctors worked on salary rather than for fee, and had as much economic incentive to keep people healthy as to treat their illnesses.
- Group practice. Instead of a scattering of physicians, physicians of many specialties worked together as a unit with an exclusive arrangement. This provided comprehensive and coordinated care.
This system integrated the delivery of care and the financial aspect of care into one organization. By doing so, care could be fully coordinated. Today, Kaiser Permanente is the model for 21st Century care, offering fully integrated and coordinated care. Kaiser Permanente now has the nation's largest and most comprehensive electronic medical records system.
This model of managed care allows patients accessible and afford comprehensive care.
Question: Does managed care work well with seniors/
Answer: Managed care works well for everyone, and particularly for seniors since it offers comprehensive care at an affordable price.
Question: I Understand that Kaiser Permanente offers an array of medical plans for seniors.
Answer: Yes. There are a variety of plans that your viewers can find out about by contacting Kaiser Permanente. We will be glad to share the details.
Comprehensive health care that is affordable and directed by physicians...the right kind of managed care may offer you significant benefits. To learn more about managed care or Kaiser Permanente's Medicare plans, give them a call at the number that's next. My thanks to Dr. Ron Copeland.
