Filling in the Blanks of Managed Care

Amanda Cavanagh

Director, Research and Business Development

I have a background in healthcare and technology so I am accustomed to acronyms, industry terms, and catchphrases.  “If you know one ______, then you know only one ______” gets a lot of mileage. I have heard this expression used in a wide array of settings to convey complexity and uniqueness. My question is how does it translate into managed care?

I recently attended the Medicaid Managed Care conference hosted by World Congress in Washington D.C.  This event brings together an impressive group of leaders from managed care, long term care, CMS, state and Medicaid organizations.  Each leader brings a unique perspective, industry expertise, and desire to collaborate for the benefit of the individuals served.

A managed care model is utilized to finance and deliver healthcare to primary and acute patient populations. The goal of a managed care organization is to improve the quality of patient care while simultaneously reducing the cost of health benefits. 

Medicaid managed care leaders emphasize that the incorporation of stakeholder engagement is essential to the development of an integrated Managed Long Term Services and Supports (MLTSS) program. The design of an MLTSS program seeks to uncover how managed care can be sensitive to the unique needs of a given population in a delivery model where streamlined supports are services are the goal.

As managed care continues to influence the development of MLTSS, the catchphrases we use to convey importance can be revisited, analyzed and, ultimately, challenged. If you know one patient do you only know one patient? Yes. But knowing one patient does not mean you only know one MLTSS consumer. Further, knowing one patient does not mean you know the entire market.

In other words, the goal when filling in the blanks should not be “one word fits all”.  We must recognize how words can elevate individuals and their uniqueness and complexity when redesigning models of care.

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