President’s Message: Healthcare Reform Expands Opportunities for Care Management Programs

Earlier this spring, the big health care news was of course the adoption of The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010,¹ which were both signed into law in late March by President Obama.

Major media outlets have extensively covered many of the highly visible issues associated with the new laws such as expansion of coverage to the uninsured and underinsured, the restrictions on pre-existing conditions and the expansion of high risk pools.

Other provisions in the new law have received little or no attention in part because they appear to be well received by both political parties and are not controversial. The new law, in many of its provisions, explicitly supports expanding access to chronic disease management, case management, wellness and readmission programs. Although the details of these programs still need to be worked out by the Secretary of the U.S. Department of Health and Human Services (HHS), Kathleen Sebelius, and her staff, it appears that Congress and the President have embraced the fact that care management interventions should be used to improve clinical and financial outcomes for the American people. With the high medical costs associated with obesity, smoking, diabetes, and other chronic conditions, stakeholders from both sides of the aisle are supporting these initiatives.

This reinforcement of the goals to control costs through improving patient health and outcomes are a reminder that care management has been on the right track for years. At Alicare Medical Management, in addition to our traditional utilization management and case management programs, we offer integrated and standalone care management services that also include chronic disease management, wellness programs and a program that manages readmissions.

The new law also establishes “quality” as a centerpiece of its strategy. We always have emphasized a quality approach in how we support patients who participate in our care management programs. Our multiple URAC accreditations are just one way we document our standards of excellence.

Although it will take many years to fully implement some aspects of the new law, we hope that this new direction that supports the investment in achieving a healthier population will be front and center for a long time to come.

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