Managed Care is Dead…. Long Live Managed Care A quick history and overview of America’s private health insurance plans Jonathan P. Weiner, Dr. P.H. Professor or Health Policy & Management Johns Hopkins Bloomberg School of Public Health ([email protected])
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Managed Care is Dead…. Long Live Managed Care A quick history and overview of Americas private health insurance plans Jonathan P. Weiner, Dr. P.H. Professor.
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Managed Care is Dead…. Long Live Managed Care
A quick history and overview of America’s private health
insurance plans
Jonathan P. Weiner, Dr. P.H.Professor or Health Policy & Management
Most Americans get health insurance “privately,” but the public sector bankrolls almost half of all care
.
Source: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group,
Private Funds
Public Funds
(% Distribution of Personal Health Expenditures by Payer, 1980-2006)
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The Most Important Chart in this Presentation: (Private Health Insurance Premiums, Worker’s Earnings and General Inflation, 1988-2007)
.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007;
18.0%
14.0%
8.5%
0.8%
11.2% *
12.9% *13.9%
10.9% *
8.2% *
5.3% *
9.2% *
12.0%
7.7% *
6.1% *
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20% Health Insurance Premiums
Workers' Earnings
Overall Inflation
3.7%
2.6%
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The “Rise and Fall” of Managed Care is Embodied in this Trend Line
In the late 1980’s the bankrollers of the system said enough was enough, and the era of “managed care” was born. HMOs and their techniques served as the model.
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Managed Care Organization's Approximate Share of the Health Insurance Market in 1988 & 2008
1988
FFS 75%
MCO 25%
FFS 75% MCO 25%
2008
FFS 15%
MCO 85%
FFS 15% MCO 85%
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The US Health Insurance / “Managed Care” Models (and approx market share in 2008)
• Traditional Fee-for Service (Unmanaged)
– 15% (Mainly Medicare)
• Preferred Provider Organization (PPO) and other “loose” managed care plans
– 47% (includes “consumer defined health plans” / “high deductible health plans”)
• Health Maintenance Organization (HMO)
– 38% (includes “point of service” “open-HMO”)
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The Key “Ingredients” of Managed Care
• Care “management”
– aka, utilization/disease management
• Vertical integration / coordination of independent providers
• Financial risk sharing with providers and consumers
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Types of health plans have shifted over the years (employer based plans)
* Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988.
73%
46%
27%
10%
8%
7%
4%
5%
5%
3%
25%
21%
20%
21%
11%
26%
28%
39%
42%
46%
52%
54%
55%
61%
60%
57%
7%
14%
24%
21%
23%
18%
17%
15%
15%
13%
13%
4%
5%
3%
3%
16%
21%
31%
28%
29%
24%
27%
24%
0% 20% 40% 60% 80% 100%
1988
1993
1996
1999
2000
2001
2002
2003
2004
2005
2006
2007
ConventionalHMOPPOPOS-HMOCDHP/HDHP
*
*
*
*
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Private managed care plans care for the majority of Medicaid / S-CHIP enrollees (Trends ‘90-’04)