ACP SAYS MANAGED CARE STRATEGIES SHOULD FOCUS ON IMPROVING HEALTH OUTCOMES

The following information was released by the American College of Physicians (ACP):

Managed care strategies employed by insurance plans should have the goal of improving health outcomes for patients rather than focusing solely on conserving costs, says the American College of Physicians (ACP). In a new paper, "Principles of Managed Care: A Position Paper from the American College of Physicians" published today in Annals of Internal Medicine, ACP addresses the complex issue of managed care and offers recommendations to protect patients and allow physicians to provide better care.

Managed care refers to health care payment or delivery models wherein the plan coordinates how members use it to control cost. Most health care plans in the United States use managed care strategies to control enrollees' coverage. With health care costs rising at record rates, the use and misuse of these strategies is likely to increase. Strategies such as prior authorization and narrow clinician networks have far-reaching implications for patients and physicians, such as administrative burden, delayed or foregone care, and negative health outcomes.

The paper offers recommendations to protect the patient-physician relationship, prevent inappropriate restrictions on access to care, and ensure that the primary goal of managed care is to improve health outcomes, not solely reduce costs. The recommendations include streamlining payments and administrative processes and providing physicians with means to more effectively advocate on behalf of patients. Evidence-based standards and current guidelines should inform utilization management decisions. Plans should maintain transparency and ensure patients can access equitable, high value, medically necessary care in a timely manner.

"Managed care plans too often create barriers to better health for patients and disrupt the patient-physician relationship," says Jason Goldman, MD, MACP, president of ACP, "Because the vast majority of health coverage in our country is through managed care plans, overly restrictive or burdensome methods of controlling enrollees' utilization substantially restricts access to care for our patients. ACP's policy recommendations would protect patients, ensuring they can access high-value care, and reduce administrative burdens for physicians."

The paper concludes that plans must collaborate with patient advocacy organizations, physician associations, policymakers, and other key entities to ensure that the top priority is the mutual goal of connecting patients to high-value, evidence-based care.

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About the American College of Physicians

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 162,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness.