When subtraction is a plus - impact of managed care techniques on cost, length of stay, admissions - Integrating Managed Care

Business & Health,  Annual, 1991  

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In almost any health care area one chooses to measure, managing the care provided not only brings down the cost, but also improves treatment for the patient--and his or her quality of life. In this special issue's "Data Watch," the impact of a number of managed care techniques is measured on such parameters as annual admissions, average length of stay, and cost of admission. For example, according to the National Center for Health Statistics, annual admissions per 1,000 people were up by six cases in 1989 over the previous year for all sources of health care services. Admissions were up four cases for HMOs. But where utilization and case management were applied admissions per 1,000 were down four cases in 1989.

The progressive effect of the application of a number of managed care techniques is well illustrated by a drug benefit cost comparison. In November, 1989, the projected cost of the pharmacy benefit for a typical HMO was $6.80 per member per month. But with the initiation of a new pharmacy network and new service agreements, the cost of the benefit plummeted to $5.70 per member per month. When a mandatory generic substitution and mandatory drug formulary were installed, in July of 1990, the cost of the benefit fell to $4.50. Projected cost absent any managed care techniques: nearly $8.00 per member per month.

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COPYRIGHT 1991 A Thomson Healthcare Company
COPYRIGHT 2004 Gale Group