MCO failure may lead to a wellness opportunity
MCO failure may lead to a wellness opportunity
Managed care has not been the boon to wellness predicted by many health promotion experts, but this loss may be a gain for wellness professionals, says Robin Foust, PAHM. Foust is a principal with Slabaugh Morgan White & Associates, a Richmond, VA-based consulting firm specializing in benefits, actuarial services, health care management, human resources, and managed care.
"In many companies where they counted on managed care to take over their employee wellness concerns, they've found those providers haven't measured up," she asserts. "Now, they are starting to take these initiatives back as part of their in-house thinking and planning."
Quite simply, says Foust, HMOs have not delivered on what they promised. "HMOs have traditionally been touted as having a strong emphasis on prevention and health promotion," she observes. "They have made great strides in prevention - screenings, mammograms, flu shots, and such - but they really haven't done what they said they would do in terms of managing and improving employee health and productivity."
Foust is only half right, according to Donald White, spokesman for the American Association of Health Plans, the Washington, DC-based trade association for HMOs and similar managed care organizations. "If you talk to WELCOA or a similar employer organization concerned with wellness issues, what they would tell you is that wellness is a job for employers and health plans," he says. "There's no question that of the major health delivery systems in the country, HMOs place more emphasis on prevention and wellness, but they will never be able to do the whole job. We now know that good health depends not just on patching you up when things go wrong, but it goes to your very lifestyle, and to decisions you make every day. Naturally, health plans can't be there for all those decisions. The employer plays a very important role because the worksite is a place where people spend many hours every day. If you have a smoking cessation class or an exercise program based at work, the encouragement that comes from your employer is essentially meaningful."
Interest is building
Nevertheless, Foust says, "We are seeing more interest in developing wellness programs in-house, and ensuring those types of programs are in place." This not only helps enhance the position of the wellness professional, but it benefits the employees as well, Foust asserts.
"When only a certain percentage of the employees are covered by HMO plans, you often see PPO and indemnity plans [with their own health promotion programs], and what you really want is one program to consistently target all employees and monitor the impact on health care costs," she notes.
In some cases, she says, the employer will stay with the managed care organization, but they will point out that its objectives are not being met. "Then, the MCO may seek outside help [to improve its performance,]" she says. "The employees benefit either way."
[For more information, contact: Robin Foust, Slabaugh Morgan White & Associates, 7204 Glen Forest Drive, Suite 304, Richmond, VA 23226. Telephone: 804-673-4282. Fax: (804) 673-3309. E-mail [email protected].]
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