EVOLUTION OF EMPLOYER-BASED GROUP HEALTH INSURANCE: FROM INDEMNITY/SERVICE PLANS TO MANAGED HEALTH INSURANCE PLANS – THROUGH 2000

READING 2.C.:

THE PHILOSOPHY OF MANAGED CARE – A FOCUS ON CONTINUOUS, COMPREHENSIVE, COORDINATED HEALTH CARE FOR INSURANCE PLAN ENROLLEES:

A. Kaiser Permanente’s philosophy of Managed Care, which focuses on the primacy of Primary Care and the necessity for highly coordinated efforts by insurers and providers, was a major inspiration for the types of Managed Health Insurance Plans implemented throughout the 1990s.

B. Essential to the Kaiser Permanente philosophy was the belief in the primacy of Primary Care within the system by which personal health care services were delivered in the United states. This belief, championed from the 1960’s and thereafter by policy makers such as Barbara Starfield, asserted that reasonably priced quality health care could only be delivered on a routine basis if patients worked closely and routinely with assigned Primary Care Physicians (individuals and/or teams).

C. At the heart of this belief in the centrality and primacy of Primary Care was a belief that Primary Care Practitioners were best equipped to ensure that patients and their families received Continuous, Comprehensive, and Coordinated patient care.

	PRIMARY CARE PRACTITIONER’S ROLE: THE CORE OF THE 3 C’s MODEL
Continuity	Sees patient regularly over time for a large proportion of the patient's health encounters (providing longitudinal rather than cross-sectional care).
Comprehensiveness	Cares for most of the patient's health problems; capable of dealing with substantial comorbidity in those with multiple chronic problems.
Coordination	For the minority of problems that require services from other providers, arranges the referral, test, or procedure and collates the results.
Contact—first	Whenever possible, is willing to be the first provider the patient contacts for episodes of illness or health concerns