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Managed Care: The Next Generation

Summary Managed care today affects most Americans. Of the 160 million Americans receiving employee coverage, 120 million are in a managed care setting. HMO development to date has been driven by the desire to reduce health benefit costs for employers. Employees, the real consumers, perceive a clash between “good care and good profits.” Health plans have generated profits by reducing utilization and keeping a portion of the savings. In the future, market conditions will force plans to develop new ways of maintaining profitability. Also, plans will survive by focusing on factors that matter most to consumers‐such as overall care quality and access. Care systems that combine the benefits of open‐access systems with the benefits of point‐of‐service products represent the next generation of consumer‐driven healthcare.