Managed Care In Your Future

Isn't managed care old hat? Something we obsessed about in the '90s and promptly forgot when the pundits were proven wrong? Perhaps, but it's time for another look.

There may be a tsunami headed our way, driven by managed care organizations taking another run at Medicare beneficiaries. HMOs and PPOs are rolling out Medicare Advantage plans in droves.

We're living in an environment that is far different than it was just 10 years ago. Over the next 10 years, it's very likely that people who become eligible for Medicare will increasingly choose a Medicare Advantage plan.

Participation in managed care by HME providers is mandatory for future survival. Many independent or regional providers may be able to navigate the competitive managed care sea safely, although it won't be easy to go it alone. It will be expensive, and the experienced talent necessary to achieve objectives may be hard to find — but there is certainly opportunity for growth.

Noteworthy Trends

• Demographics

  The numbers are staggering:

  • 43 million people enrolled in Medicare.

  • 55 million enrolled in Medicaid.

  • 8,000 baby boomers turn 60 every day.

  • Population is shifting from traditional strongholds to coastal areas.

  • The U.S. population hit 300 million in October 2006. Immigration continues to grow dramatically. Immigrants account for 40 percent of the nation's population growth, according to a recent Wall Street Journal article. This explosive growth will result in language, cultural, income and education gaps.

  These trends will put enormous pressure on the nation's health care delivery and financing systems. Home care will become an increasingly important setting for health care delivery.

  It's likely that the country's 78 million baby boomers will demand home care alternatives to maintain their independence as long as possible. This is not a generation that intends to fade quietly into the background. Many boomers insist they plan to work well beyond traditional retirement.

  The success that payers and home care providers have in addressing concerns about medical necessity and appropriateness of care will determine both the scope and amount of services provided at home. The HME industry must be prepared to work with payers to develop technology that reduces the cost of care and provides effective oversight.