You know the saying about giving someone a fish as opposed to teaching him to fish. Well, a lot of consumers are going to feel that the medical industry has told them to go fish, and forgot to include the lessons. Enter the health plan. Our cover story by Contributing Editor MargaretAnn Cross shows just what consumers are up against. As the story points out, presenting medical management as a benefit to members as opposed to something the health plan is doing to improve its bottom line may make consumers more accepting of the programs, reduce costs to the payer (the employer or government), and help plans to do their jobs better.
I was pleased and gratified to learn that far from abandoning the enrollee, current CDH plans seem to provide enough guidance to push the patient in the right direction. CDH plans are usually described as if they were basically old-fashioned indemnity coverage (deductible, catastrophic, "we'll cover 80 percent"). Evidently, the terminology and the reality are not the same: CDH might not involve prepayment, as in an HMO, but it sure involves managing care.