Why Care Coordination Is The New Managed Care

Managed care often feels like a taboo subject within the healthcare industry. Why? Because traditional managed care failed. Through HMOs and PPOs, it promised to improve outcomes and decrease costs, but it was unable to accomplish either goal.

Despite its failure, the promise of managed care is still good. Improving outcomes and decreasing costs is a meaningful goal that benefits every stakeholder in the healthcare industry, including payers, employers, and their members. But, a new approach is needed to actually make it happen.

But why did the old system fail? And why is care coordination the reboot we need to fulfill the promises that managed care never could?

The Old Model: Managed Care

Traditional managed care attempted to control costs by keeping patients away from more expensive forms of care, like the hospital, ER, and urgent care. It did this by focusing on primary care and utilizing a network of preferred providers.

So when a patient needed to see a specialist, in order to save costs, their provider would refer them to someone in-network. But the cost savings never happened. It didn’t work. 

This type of control, all in the name of cost savings, was little more than a quick fix. It was incapable of addressing the root causes of many people’s poor health — their lifestyle choices.

In fact, it actually prevented people from getting the care they needed, when they needed it because of:

• Poor access to care
• Limited engagement with their providers
• Lack of empowerment to make positive lifestyle choices

Most members ended up frustrated and unhealthy, with nothing more than a prescription to solve their problems. Payers and employers had to face the fact that managed care was not improving health outcomes and total cost of care was still prohibitively high.

The New Model: Coordinated Care

Now, managed care has been rebooted into coordinated care. Like traditional managed care, coordinated care also focuses on delivering primary care as a patient’s main source of healthcare. However, it stretches beyond what managed care was able to accomplish by targeting the root problems of health, including poor access and a lack of emphasis on behavior change.

At Vera, our on- or near-site care centers deliver on the promises of managed care but are backed with the power of the coordinated care model. Here are three ways this strategy makes a real difference for payers, employers, and their members:

1) Easily Integrates into Benefits Plans

The on-site care center model offers more opportunities for coordinating care, because it fully integrates into an organization’s benefit strategy. Providers can refer to in-network specialists who are both high-quality and low-cost, reducing total cost of care for members, employers, and payers. Recommendations and findings from specialists are also incorporated into members’ personalized care plans, creating a more connected health journey.

2) Integrated Health Coaching and Longer Appointment Times

Care teams at Vera on-site care centers are trained in behavior change practices that empower patients to take ownership of their health. Vera whole health coaches are embedded into each team, because their work is key to unlocking meaningful change for members, helping them improve their satisfaction, productivity, and quality of life.

Our proven advanced primary care (APC) model also includes longer appointment times, meaning patients spend more time with their providers and Vera health coaches. This encourages the development of meaningful, empathetic connections. Providers are better able to identify problems, close care gaps, and develop personalized care plans addressing the root causes of health issues. 

This approach is especially beneficial for patients with chronic conditions, such as diabetes, because those chronic conditions are best mitigated by positive lifestyle choices.

3) A Comprehensive Digital Experience

Now, Vera and Castlight Health are combining to further the possibilities of care coordination. Castlight’s connected navigation platform acts as a digital front door to care, allowing greater access, more unique personalization, and improved engagement. Providers will be supported even further in holistically managing care built around the needs of each patient. 

Together, Vera and Castlight are committed to delivering world-class patient experiences, helping employers and payers support a culture of care for their members.

Editor's Note: This is an updated version of the original post published on March 5, 2019.