Planning for women's health care services

Abstract

Managed care organizations have an opportunity and an obligation to provide comprehensive health care services to women. The opportunity arises from the nature of the health insurance arrangements linking a woman, by contract, to one insurer for all her health care needs. As the sole-source provider for care, the managed care organization has the opportunity to plan for and to coordinate the implementation of the complete array of needed and desired services for women of all age groups. With this opportunity comes the obligation to try to provide not only what is medically appropriate but also what is preferred. In order to plan for needed health care services, our organizationHarvard Community Health Plan-used a process for clinical program planning. Harvard Community Health Plan (HCHP) is a mixed model, nonprofit health maintenance organization (HMO) in New England, with a membership of more than 500,000. (At the time of this publication, a merger with Pilgrim, a New England-based independent practice association [IPA] model HMO, will be in process, resulting in an organization of more than l,OOO,OOO members named Harvard Pilgrim Health Care). Clinical program planning uses population-based approaches to guide the identification of improvement initiatives, focusing on best opportunities to improve clinical outcomes, customer satisfaction, and costs. This approach is being adopted increasingly by the larger, mature managed care organizations, with some early successes.1’2 Improvements are achieved through identifying and implementing optimal care processes and essential support programs. Measurement of key outcomes and overall program evaluation allows for assessment of effectiveness of current program and for identification of future opportunities. The vehicle used to oversee this process in our organization has been the development of steering committees, consisting of clinical leaders and managers from the various divisions of the organization. Steering committees have been established for the initial priority clinical areas of the organization: asthma, diabetes, pediatric prevention, mental health and substance abuse, and women’s health. The Women’s Health Steering Committee has met bimonthly over the past year with the goal of developing a mix of strategies to yield short-term, mid-term, and long-term improvements in health care for women.