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Clinical Preventive Services

Managed Care

Presenter:

Ned Calonge, M.D., M.P.H., Chief, Preventive Medicine and Research, Kaiser Permanente Colorado, Denver, CO.


The structure of managed care prevention programs allows for the implementation of many effective preventive care strategies. Examples of some managed care organization (MCO) prevention strategies include:

  • Childhood and adult immunizations.
  • Smoking cessation counseling.
  • Breast and cervical cancer screenings.

Health plans have many motivations for providing preventive care services to their consumers. Among these are:

  • Improvements in health status.
  • Accreditation requirements.
  • Public quality comparisons.
  • Marketing.
  • Retention of enrollees.
  • Cost control.

Some of the barriers to achieving wider use of preventive care services include:

  • Cost to MCO (including cost of unnecessary or unproven interventions).
  • Attitudes and beliefs of patients and providers (i.e., prevention is an ineffective use of time and money).
  • Providers' traditional passive practice styles.
  • Competing priorities for both physicians and patients (i.e., busy schedules).

Successful managed care prevention programs share several common characteristics:

  • An effective data collecting and tracking system.
  • Use of clinical guidelines.
  • Provider and patient incentives.
  • Quality improvement programs.

Strategies to encourage patient and provider involvement include:

  • Education.
  • Habit-building.
  • Outreach.
  • Training.
  • Economic incentives.

Quality improvement programs provide a focused approach to improving utilization of preventive care services through:

  • Periodic monitoring.
  • Reporting.
  • Intervention design.
  • Implementation.

Performance measures can include:

  • Penetration of proven procedures into the market.
  • Overutilization.
  • Use of unproven procedures.
  • Intermediate outcome measures.
  • Total costs.
  • Cost-effectiveness.

To promote preventive care services in MCOs, State and local governments need to:

  • Promote the development of statewide childhood immunization registries.
  • Support the use of report cards.
  • Encourage the review of National Committee for Quality Assurance accreditations when evaluating MCOs.
  • Develop other policies to promote the appropriate utilization of effective preventive care services.

References

Garr DR, et al. LD: The effect of routine use of computer-generated preventive reminders in clinical practice. Am J Prev Med 1993;9(1):55-61.

Ornstein SM, et al. A comprehensive microcomputer-based preventive services system for the family physician. J Am Board Fam Pract 1993;6(1):55-60.


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