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CMW News: Some hospitals, payers favor a return to managed care

Case Management Weekly, September 17, 2008

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While hospitals, healthcare professionals, and politicians are all desperately looking forward for a solution to improve the quality and financial aspects of healthcare in the United States, some health insurers and providers are looking back to the flat-fee reimbursement days of the 1980s and 90s.

Blue Cross Blue Shield of Massachusetts, along with the state’s second-largest hospital network, Caritas Christi Health Care, believes it can provide better care by returning to the managed care strategy. With this approach, Blue Cross Blue Shield would pay providers a flat, yearly fee per patient based on the patient’s age and level of illness. Caritas believes this would not only help it to bounce back from struggling times, but would improve patient outcomes by putting more emphasis on prevention.

Experts say getting others to buy-in to this approach will not be easy. Many physicians have become accustomed to getting paid for each test and procedure they perform. Also, patients may remember being turned away from managed care in the past when the care they required was deemed too costly by the provider.

Source: Business Week

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