MANAGED CARE AND
QUALITY SERVICES
The Importance of
Person Centered Outcomes



Managed Care refers to the cooordinated attempt to control health care costs through a variety of strategies and methodologies. The basic strategies and methodologies address utilization of services, the prices paid to providers, and the price paid by the user. Managed Care strategies include risk management, utilization management, prior authorization, concurrent review, limitation of benefits, peer practice review, service coordination, channeling, bundling, and prevention and health promotion.

In the past, we equated managed care with health maintenance organizations. Now, however, managed care has taken a center stage in the delivery of health care. The movement toward managed care is driven by the increase of health care costs and the increase of uninsured citizens. Both are rising at the same time.

For the past decade, large businesses and corporations have supported managed care as a means to controlling their health care costs. More recently, states have begun to shift Medicaid recipients to managed care programs. In addition, states have begun to shift mental health and addictions services into managed care systems. Finally, states are now attempting to extend managed care systems to the services and supports for people with developmental disabilities.

In order to participate in the dialogue about the emerging managed cared system for people with disabilities, take the following steps:

  • Recognize that maanged care, in one form or another, will be incorportated in services for people with disabilities. In fact, many methods employed by managed care systems in acute and chronic health care are already in place in the financing of services for people with disabilities.

  • Learn the language. There are hundreds of different managed care methods, techniques, and practices. In reality, the number of acronyms in managed care probably exceeds those in the field of human services and disabilities. This means that there will be alternative methodologies for implementing managed care goals. Some of these alternatives will be better and some will be worse in terms of the impact on people with disabilities.

  • Define the level of quality the managed care system will provide. Managed care does not necessarily negate quality. At crtical points in the unfolding of the managed care system in the states, the managed care provider must define the quality of services to be provided. Self-advocates, families, and professionals need to participate in this discussion and define the measures of quality that will guide the managed care system.

  • Measure outcomes for people to assess quality in services and system. Outcomes are the critical indicator that systems and organizations are using resources to achieve desired results for people.

  • Focus resources on person-centered outcomes. Identifying and addressing specific and priority outcomes for the individual is more cost effective than provideing a broad range of less important services.

  • Decrease organizational process regulatory requirements. Process-oriented standards impede the implementation of managed care principles.

    •  Financers and self-advocates will care about cost and results, money and person-centered outcomes. If self-advocates, families, and professionals participate in the design of the managed care system, they can use person-centered outcomes to define the quality expected from managed care expenditures.



    Posted from
    Update on Quality
    Volume12, Number 3
    October, 1995



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