November 2003

Managed Care Steps Outside Its Traditional Role to Help Patients & Control Treatment Cost

The greatest challenge facing the health care industry today is escalating costs. PacifiCare Behavioral Health (PBH) takes an approach that runs contrary to many in the managed care industry. The company believes in ensuring its members receive both the right type and right amount of care from those clinicians who have demonstrated the best outcomes. This puts the focus on care not costs. PBH calls this approach Best Care. Paradoxically, the result is lower treatment cost, which ultimately contributes to more manageable rates for the health care purchaser. The most notable example of how PBHs approach works is the company's Assertive Case Management (ACM) program. Since 1999, PBH has relied on its ACM program to support its most severely and persistently mentally ill members. The primary aim of this program is to help high-risk members reach and maintain their highest possible level of functioning, thereby reducing reliance on inpatient services.