HI_Future_09 - A History of Managed Care and Health...

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    A History of Managed Care  A History of Managed Care  and Health Insurance of the  and Health Insurance of the  Future Future PAM 4350 February 24, 2009 February 24, 2009
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    Help in the fight against malaria Help in the fight against malaria Work to increase malaria Work to increase malaria awareness awareness on campus and in on campus and in Ithaca, strategize to help Ithaca, strategize to help prevent prevent malaria, and malaria, and distribute distribute bed nets to those most in need. bed nets to those most in need. Cover Ghana Cover Africa / Service – Cover Ghana Cover Africa / Service – Learning Trip to Ghana Learning Trip to Ghana Information Sessions Information Sessions You only need to attend one info session You only need to attend one info session Wednesday, February 25th 5 to 6 pm in GS 132 Thursday, February 26th 5 to 6 pm in GS 142 Please contact John Lee Please contact John Lee ( lee.john2010@gmail.com)  if you have any  lee.john2010@gmail.com)  if you have any  questions. questions.    
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    Today’s Objectives What is managed care and how was it able to take over the health insurance industry in the 1980s and 1990s? Did managed care work? Is managed care working now? What type of health insurance plans are likely to be popular in the future?
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    -2 0 2 4 6 8 10 12 14 16 18 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05 '06 '07 '08 Source: Kaiser Family Foundation, Employer Health Benefits 2008 Annual Survey. Percent Change Average annual % change in private health insurance premiums Health Insurance Premiums Grew Rapidly Throughout 1980s and Early 1990s 4.8% 13.9%
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    0.91 0.62 0.44 0.25 0.08 0.05 0.03 0.02 0.01 0.21 0.26 0.26 0.41 0.55 0.60 0.58 0.00 0.00 0.08 0.16 0.22 0.15 0.13 0.12 0.08 0.17 0.22 0.29 0.25 0.2 0.2 0.33 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1984 1988 1992 1996 2000 2004 2006 2008 High Ded HMO POS PPO Indemnity Enrollment by Type of Insurance Plan at Firms With 200+ Employees Source: KPMG Surveys of Employer-Sponsored Health Benefits, 1984-1998. Foster Higgins, HIAA, AAPPO; Kaiser/HRET Survey. Managed Care Had Less Than a 10% Share of the Health Insurance Market in 1984 8% 4% High deductible plans
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    Schematic on What a Health Insurer Does Health Insurer Providers: - MDs - hospitals - pharmacies… Enrollee/ Worker Employer Pay a premium regardless of whether a person receives any medical care Cost sharing if/when patient receives medical care (e.g., co-payment or deductible) Pay providers when enrollees receive care - determine which providers to include in the network - determine how & how much to pay providers - “manage” the medical care provided to minimize low-value, high-cost care
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    How Did “Indemnity” Health Insurers Operate? Allowed enrollees to see any physician and be admitted to any hospital in an area (i.e., a broad provider network). Paid physicians and hospitals fee-for-service : after medical care was provided to an enrollee, the provider submitted a claim based on what services/procedures the provider actually performed, and the health insurer paid the claim.
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This note was uploaded on 04/25/2009 for the course PAM 4350 taught by Professor Nicholson during the Spring '08 term at Cornell University (Engineering School).

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HI_Future_09 - A History of Managed Care and Health...

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