The Emerging Role of Community-based Agencies in the Managed Care Environment

The term managed care or managed healthcare is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing for profit health care and providing health insurance while improving the quality of that care (“managed care techniques”).  It has become the essentially exclusive system of delivering and receiving American health care since its implementation in the early 1980s.  Over the past thirty years managed care has continued evolve.  According to the trade association America’s Health Insurance Plans, 90 percent of insured Americans are now enrolled in plans with some form of managed care.  While state government have mostly “carved out” vulnerable populations from managed care arrangements, 26 states have contracts with managed care organizations to manage long-term care services for the elderly and individuals with disabilities.

Today, as part of a national trend, this is changing.  States are slowly starting to move vulnerable populations such as children and adults with disabilities and individuals with mental health issues, into managed care systems. This far-reaching change has significant implications.  Managed Care companies are been reaching out to the traditional providers of care to these populations, creating partnerships that will, I believe change the provider landscape.

As the Fedcap Group is immersed in preparation for these changes, we are also advocating for the way that they unfold.   The populations that will be moved into managed care arrangement often face social barriers and have chronic, complex conditions. Effective care coordination is imperative to meet the needs of these individuals and requires strong relationships between medical providers, insurance companies, social service agencies, and individuals and families.

Further, we are interested in exploring the social determinants of health, which research suggests are the “secret sauce” of truly improving population health, patient experience, and the cost of care. These social determinants include such things as:

  • Availability of resources to meet daily needs (food, transportation, housing);
  • Access to affordable education;
  • Access to job training and employment opportunities;
  • Availability of community-based resources;
  • Social supports; and
  • Socioeconomic conditions (concentrated poverty and the stress that accompanies it).

Comprehensive solutions are needed as vulnerable populations shift  to managed care. With a person-centered focus, state-of-the-art technology, expertise in helping people access benefits, and data to quantify our intervention and prove our impact, we look forward to being part of that solution.