Managed Care in Long-Term Care

Life Without Managed Care. Is It Only a Dream?

Managed Care is often sighted as one of the major problems facing physicians in medicine today. It is blamed for physician burnout, decreased job satisfaction and even increased cost. Why then, do we put up with it?

“Because that’s the way it is.” “You can’t be in medicine, especially primary care without joining them.” Isn’t that the line we hear? Slowly, physicians like you and me are beginning to question the wisdom of participating in these plans. In the long run, depending on your goals, it's often better to avoid them. This is especially true in Long-Term Care.

Please let me clarify something. When I speak of managed care, I mean the restrictive, capitated versions of HMOs. I'm not, nor do I pretend to be, an expert in this field of insurance products. But I do know you don’t have to put up with them in Long-Term Care.

Managed Medicare Penetration

Medicare beneficiaries are being bombarded with supplemental plans, managed care plans and prescription benefit plans daily. Many have been burned in the past and are a little gun shy. Depending on who you listen to, the market penetration into the Medicare market is, at the most, around 30%. There is a wide regional variation. There are many complex networks, especially in urban areas. These fall off in more rural markets.

The market is changing and adapting daily to changes in law and markets. It's very complex and follows the rules of business. It's not driven by patient need. It's involved with selling a product and seeing if the market buys. So far they haven’t quite got it just right. That’s good for you and me. We can for the most part ignore them and concentrate our efforts on traditional Medicare.

Medicare Managed Care Plans Actually Cost More

The idea behind managed Medicare plans is to reduce overall costs through the management of medicine. Unfortunately, with the Medicare market with its high utilization, this resulted in an unwanted increase in cost beyond the usual fee-for-service model of traditional Medicare.

I'm greatly simplifying the issues here, but the managed Medicare plans don't offer enough financial, medical or personal advantages to justify the additional burdens placed on the medical establishment. In fact, they cost more than regular Medicare. They respond by saying they offer more benefits than traditional Medicare.

These additional benefits usually aren’t helpful to the typical Long-Term Care patient. Frequently, I see patients who require Long-Term Care revert back to traditional Medicare.

I knew early on, when I saw all the extra hassle, frustration and wasted time that I didn’t want to participate in any of that nonsense. I’m here to tell you that in Long-Term Care Medicine, you don’t either.

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