I remember once reading an article several years ago in which brilliant author Dave Berry dissected 2 different Presidential primary candidates’ stump speeches. The point of his article was to show you that a good political speech can have have all of the words of its sentences scrambled and paragraphs interchanged and the message of the speech will not change at all.
Borrowing this same technique, health insurers are now recasting managed care as care management. I ran across this and other tidbits while reading the very respected Center of Studying Health System Change (HSC) most recent report. HSC is typically very insightful and uses detailed surveys of the metropolitan health care markets to describe trends in health care. It’s an easy report to read but if you don’t want to waist your time-not much has changed recently and although some aspects of consumerism are occurring, the bottom line is that little really has changed since 2005.
Care Management trends are showing that pre-authorization is coming back-albeit a little more sophisticated in terms of the use of IT and “real time” data analysis. This can be both concerning to PT as we long remember managed care’s (as it was known then) tendency to make us go thru the “hoops and ladders” of visit authorization, approved codes, and artificial limitations in coverage and intervention. All of this was purported to be going away due to provider backlash. Under Care Management (as it is known now) it is on the rise.
In fact, providers are buying UM vendors and incorporating them directly into their processes-particular for imaging where some select providers are given a “free pass” based on data while others have to go thru the pre-auth process. Apparently, the “free pass” is based on utilization data and history of those providers. Specialty pharmaceuticals and bariatric surgical providers are also on the radar screen of these processes as well.
Don’t be too surprised when (not if) this hits the physical therapy industry. It will be in Yogi’s words “Deja Vu all over again” but we will feel better because it is now called care management.
Thoughts?
