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Not All Medicare HMOs Are Created Equally.

Colorado Springs, CO

Have you considered managed care versus integrated care? What is the difference? Do I have what I need?

When it comes to choosing the best Medicare plans for yourself or a loved one HMOs (Health Maintenance Organization) are often a viable choice due to affordability, predictability, and financial safety. All HMOs operate based on the concept of managed care… but not all have integrated care. It is important to be aware of the difference.

Let’s start with managed care. This is when health insurance organizations contract with select providers, pharmacies, and hospitals in their service area to create a network that allows for better control of costs. As a result of this arrangement, members agree to seek non-emergency/non-urgent care with network providers in exchange for lower costs of care.

The primary advantage of the managed care aspect associated with HMOs is the focus on the cost of care which benefits the member and the health plan.

Integrated care, however, is when the health plan and providers work together, in close coordination and collaboration, they have a shared focus on the patient experience, quality of care in and cost of care.

The additional focus on patient experience and quality of care is often associated with ease of access or robust IT tools resulting in easier communication across the care continuum. STAR ratings are solid indicators regarding performance for quality of care for health plans. When it comes to IT, you’ll want to ask what electronic communications options exist with the health plan you are considering. If available, they may allow for better communication to patients and providers, as well as between providers.

There is so much more to learn about with respect to integrated care… be sure to ask your potential health plan what tools or resources are available that promote integrated care. Some health plans with impress and overwhelm you… and some may not be able to give you a straight answer.

Think of it this way: all integrated care HMOs have managed care, but not all managed care HMOs have integrated care. Be sure to ask the right questions so you can make the right decision.

 Editor’s Note: This article was submitted by Matt Engstrom, MBA. Matt is a Medicare Sales Manager at Kaiser Permanente and may be reached at  303-338-3353



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