Managed care relies on group education
Managed care relies on group education
Expert explains why this approach fails
Even with corporate America strong-arming managed care organizations (MCOs) to develop health promotion and prevention programs, many MCO efforts fail because they lack a well-developed global approach to wellness, says Larry S. Chapman, MPH, chairman and senior consultant for Summex, an integrated health management services company in Seattle.
In a recent study of health promotion programs offered by 20 health maintenance organizations (HMOs) all associated with the same employer, Chapman found that health promotion efforts lacked a central source that had access to and control over information about all the HMOs current disease prevention and management programs. In addition, the HMOs relied heavily on group education efforts with no clear target audience.
Reasons for failureChapman says health promotion efforts launched by MCOs often fail for the following reasons:
o Marketing approach.
Too many health promotion efforts in managed care are seen as marketing activities rather than true health management activities.
o Long lead time to show results.
The emphasis in health promotion is on primary prevention. "When you emphasize prevention of chronic disease, any perceived health effect occurs five to 20 years in the future. This makes it difficult to get adequate resources for programming," he explains.
o Little continuity or coordination.
Many HMOs have limited information links with their primary care providers. That situation results in limited continuity and coordination of the efforts of health promotion programs and those of physicians. In the end, the lack of coordination often leads to less effective behavioral and risk reduction outcomes in the plan member.
o Reliance on group education.
MCOs frequently fall into the trap of offering new educational offerings that attract few plan members. Low participation dilutes the perceived value of your health promotion efforts in the eyes of employers.
o Sparking internal turf wars.
MCOs must have a global approach to health promotion that clearly coordinates all disease prevention and management efforts, Chapman says. When health educators or health promotion staff begin to work with at-risk members, turf wars sometimes erupt between health promotion staff and case management or utilization management staff, he explains.
o Inadequate resources.
Price competition in many managed care markets makes it difficult to justify the additional costs of expanded health promotion programming, Chapman says.
o Excessive employer demand.
Employers have embraced the health pro motion concept and frequently make heavy demands on their MCOs to deliver programs. "Excessive demands on the managed care health promotion staff stretches scarce resources even further and forces MCOs to focus their efforts on a few demanding employers at the expense of others."
o Difficulty serving entire population.
Employers often demand that MCOs provide programming to all their employees, not just those employees who also are members of the health plan.
"It's difficult to provide that programming without charging an extra fee, but employers often feel as if they already pay enough," Chapman explains.
o Pressure for prevention activity.
With more employers focusing attention on the Health Plan Employer Data Information Set (HEDIS) developed by the National Committee for Quality Assurance in Washington, DC, MCOs are forced to address HEDIS-related issues in their health promotion programming, which leaves potential gaps in disease prevention efforts.
o Difficulty documenting effects.
MCOs face the same difficulties corporate health promotion programs do when it comes to documenting the effects of their health promotion programs, Chapman says. "There are several issues at work," he says. "You have small groups involved in most programs. You also have movement of members to other MCOs making it very difficult to document health improvements."
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