Managed care: Public-sector managed behavioral health care: VI. The Iowa approach to profit and community reinvestment.

Abstract

T public’s nightmare image of for-profit public-sector managed care is one of an opportunistic, financially driven company siphoning public money away from needy citizens to line the pockets of greedy investors and lavishly paid executives. A recent nationwide survey asked a random sample of adults if they were “worried that your health plan would be more concerned about saving money than about [providing] the best treatment for you if you are sick” (1). Sixty-one percent of respondents who were enrolled in “heavy managed care” said they were somewhat or very worried, compared with only 34 percent of those in “traditional” plans. Backlash against managed care is substantial enough to be the subject of an entire 400-page issue of the Journal of Health Politics, Policy, and Law (2). Since 1995 Iowa has addressed these fears head-on through the evolving design of its Medicaid behavioral health program. This column, which is the sixth in a series on public-sector managed behavioral health care and the second focusing on Iowa (3), addresses the lessons other states can learn from Iowa’s strategy of capping profits and mandating community reinvestment.