Managed Care - May 2008 - (Page 41) one demands only their first choices; you have to be prepared to work flexibly and high-mindedly to find the innovative solutions. We also have to find ways to immediately and more effectively support the “safety net” — community-based health centers. These centers are doing extraordinary work across the nation. They implement what we know to be important: continuous, coordinated, and comprehensive health care services. These community centers should be incorporated into our networks so that commercially insured people can use the centers. MC: Are you saying that commercial health plans should be underwriting or subsidizing community health centers? TUCKSON: I’m saying that we should be finding appropriate ways for people who have private insurance to receive care at community health centers, which will bring resources that can help sustain them economically. We have been studying and implementing this. United Health Foundation has created four centers of excellence in community health centers in the poorest sections of Washington D.C., New York, Miami, and most recently in the Ninth Ward of New Orleans. As a condition of funding, we required that the centers meet performance standards that derive from the Ambulatory Care Quality Alliance. George Washington University did a study for us of the quality of care in those clinics, and based on those standards we found that the quality of care was equal to or better than the private sector without risk adjustment. So why wouldn’t a person with private insurance be encouraged to get care there? A privately insured Latino woman who doesn’t speak English, for example, might do better in terms of managing her diabetes if she is getting care at a community health center that has translational services and other social supports. It could not only give her a better care experience, but also help to sustain the long-term viability of the clinic. That’s the point I’m trying to make. MC: You’ve been interested in the Internet and its potential to help disseminate health information since the early days of America Online. How do you feel about how the use of the Internet has evolved in health care? TUCKSON: What I am most excited about is the speed with which our industry is catching up to other consumer-oriented industries. So as I study the specificity with which I am encouraged to interact with iTunes and with Amazon, I appreciate how much progress the health care industry has made in translating person-specific information into programs that support an individual’s ability to make better health care choices. I am a former commissioner of public health, and I have experienced the frustration associated with trying to mobilize people around appropriate life-sustaining and disease-preventing behavior. In the past, we were limited to conducting campaigns through billboards, public service announcements, generic pamphlets and cajoling. Now we’re at this moment in which, because of data and information systems and the Internet, we understand that Mrs. Jones is a 55-year-old African-American woman with diabetes and hypertension who has certain attitudes about her health. That creates the opportunity for personalizing information, delivering it to her desktop, into her kitchen. We can say, “Mrs. Jones, here’s how we think we can best help you make the right choices for what you are going to eat tonight” or “Here’s how to choose the right hospital for your care.” That is enormously exciting, and it is a whole new competency that health care never had before. MC: The proliferation of online sources of health information is mind-boggling. Are health plans going to say, “Use us as your portal to get the information you need,” or are people still going to look in many different places? TUCKSON: People will always — and one would always hope they would — search widely, explore ideas and information sources, and express their curiosity. In no way would I as a health plan executive suggest that there ought to be a limitation on access to information. But what companies like ours are so excited about is being able to make personally relevant information available quickly, easily, and conveniently and do it in a way that presents a much greater opportunity for individuals to actually act upon it. People can take a health risk assessment, and we can tailor a Web site presence just for them. If they go online to do an administrative task, we can say, MAY 2008 / MANAGED CARE 41
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