PREVENTIVE CARE

Overview

Primary and secondary prevention are certainly critical activities for any successful managed care organization, and are at the core of the philosophy of managed care itself. The idea that it is better for the patient, as well as for the fiscal health of an organization, to prevent illness or detect and treat it at an early stage is fundamental to the concept of the HMO. This tenet is still central to the thinking of policy makers, insurers, employers and public health professionals concerned with extracting the most value from our nation's health care dollars.

It may not be surprising then that the profiles in this section make clear the connections between clinical prevention and public health, and include, in some cases, activities that involve collaboration among multiple health care organizations, state or local health departments and clinicians. Successful preventive health needs more than a single system within a health plan. It requires multiple systems that work together. Information, education, communication, deployment and data tracking all must exist in harmony for improvement to be realized. Often, innovative approaches are required to reach non-English-speaking populations, and those who are merely disinterested or too busy.

The practitioner and the network are critical components of all these activities, of course. But the story doesn't end there. Staff throughout, and outside, a health care organization can play integral roles. The use of contracted disease management vendors for member outreach can extend the abilities of a health plan, for instance.

The real story line of these activities is how a geographically diverse group of health plan leaders, quality experts and clinicians can come together to accomplish what all agree is a worthy and cost-effective public health goal, and then continue to improve the delivery of that aspect of care.