Managed care gets mixed reviews for cutting cost, use

Looking to curb emergency department use and cut costs? Then hospitals should look no further than the managed care model, suggests new research from the VCU School of Medicine in the February Health Affairs.

Researchers found that ED visits and inpatient admissions dropped for uninsured, low-income patients continuously enrolled in the Virginia Coordinated Care for the Uninsured, while primary care visits increased during the seven-year study period.

The managed care approach also reduced inpatient costs for that group of patients. The average total costs per year per enrollee fell almost 50 percent during a three-year enrollment period, the study states.

The study also notes that it takes several years to realize cost savings from managed care, as enrollees' healthcare utilization changed with increased time in the program.

Meanwhile, the move to the managed care model has triggered complaints from healthcare providers in Kentucky, the Lexington Herald-Leader reported last week. Hospitals, doctors and mental health providers said managed care has led to payment and preapproval issues that have delayed treatment.

Some healthcare providers had to take out loans to pay their workers because managed care companies still haven't paid millions of dollars in outstanding claims, the article noted. At one behavioral health facility, inpatient stays jumped 30 percent, thanks to managed care companies preventing patients from staying long enough to be stabilized.

To learn more:
- here's the VCU press release
- check out the study (.pdf) (registration required)
- read the Herald-Leader article

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.