Injury Prevention and the Changing Face of Health Care

From Spring 1996
Volume III, Number 1

The term "managed care" is used to describe a variety of ways to finance and deliver health care. The most fully developed of these options, Health Maintenance Organizations (HMOs), have grown in enrollment from 6 million in 1976 to 51 million in 1994. Many insurance companies now offer managed care as well as more traditional coverage options. The growth of managed care as a health care alternative, as well as its emphasis on prevention, health maintenance, and cost control, provide traffic safety and injury control professionals with new challenges and opportunities.

Initiating a Collaboration

Managed care organizations allocate a small portion of their care budgets to prevention. Injury prevention competes for this resource with infectious disease prevention and prenatal care. It may be easier to begin working with an HMO's community relations or marketing departments, which promote the organization as a responsible provider of health protection and care.

The Safety and Health Council of Greater Omaha, a chapter of the National Safety Council, used this strategy when it involved Blue Cross/Blue Shield in its Arrive Alive impaired driving campaign. The council's Brigette Young explains:

Before we approached them, we had a very detailed outline of the campaign and a detailed budget. The message we stressed was "Not only will we cut down on traffic-related injuries, but we will get your company's name out there as a responsible provider." When you show the company they are gaining from it, the funding can come out of their advertising and marketing budget.

A second project, also from Nebraska, demonstrates another benefit of working with a company's marketing department--access to designers, writers, and public relations experts. When the Nebraska Office of Highway Safety collaborated with Blue Cross/Blue Shield on a billboard campaign for safe holiday driving, Blue Cross not only paid for the advertising space but helped design the billboards. "The suggestion for this collaboration actually came from the billboard company," says Fred Zwonechek of the Nebraska Office of Highway Safety. "The billboard company, Imperial Outdoor Advertising, had been working with both Blue Cross and the Office of Highway Safety on similar campaigns and suggested we work together. The billboards have been really popular--we've received a lot of positive responses from the community."

HMO newsletters are another valuable resource for spreading the traffic safety message. "Most HMOs have newsletters that go out to their customers," says Pat Salber of Kaiser Permanente, a large HMO based in California. "The stories in these newsletters are all about improving health." Newsletters are a useful forum for educating HMO subscribers about child passenger restraints, bicycle and motorcycle helmets, and the dangers of alcohol- or drug-impaired driving.

Choosing a Target

Bicycle helmet and child safety seat campaigns are particularly attractive to managed care organizations. The company can count (and publicize) the number of items it distributes. The subscriber receives a concrete benefit. And these campaigns work. Both Group Health Cooperative of Puget Sound and Kaiser Permanente Northwest have achieved significant increases in helmet use and reductions in head injuries through bicycle helmet programs. (See Bicycle Helmets: Still the Way to Go)

Managed care organizations can also use financial incentives to encourage safer lifestyles. Pierce County Medical Bureau, Inc., a Tacoma, Washington, Blue Shield organization, waives the copayment or deductible for injuries incurred while wearing a safety belt or motorcycle helmet. This policy started in 1987 while Washington State's motorcycle helmet bill was being debated. According to Pierce County Medical's Julie Pisto, "We wanted to support the bill in a very public way. We wanted to get across the point that injuries not only consume a vast quantity of health care dollars but also cause a great deal of pain to the families of those injured or killed in motorcycle collisions." Pierce County Medical continued to provide these financial incentives after the bill was signed into law. "There are different ways to motivate people," Pisto says. "Laws don't always do it."

Medicaid and Managed Care

The states and the federal government jointly finance Medicaid as a way of providing health care to poor and disabled people. Traditionally, Medicaid has contracted with health care providers on a fee-for-service basis. States can now apply for waivers allowing them to establish Medicaid managed care programs. These states issue requests for proposals (RFPs) detailing the core services that must be provided to recipients. Approved respondents to these RFPs contract with the state Medicaid agency to manage and provide care to Medicaid beneficiaries.

Requiring core services to include injury prevention activities is a powerful method of bringing traffic safety and injury prevention to managed care providers (as well as low-income populations, often at higher risk for injuries than the average American). Medi-Cal, California's Medicaid managed care program, includes language in its RFPs requiring providers to "collaborate in local health department community-based prevention programs." Organi-zations responding to these RFPs often incorporate prevention and education into their overall health services, benefiting all subscribers, not just those on Medicaid. A recent report by the National Association of County and City Health Officials encourages local and state health departments to take an active role in ensuring that prevention language is included in Medicaid managed care RFPs and contracts (see For More Information on Managed Care).

Looking Toward the Future

Dr. Mark Rosenberg, Director, National Center for Injury Prevention and Control, suggests that the ways in which Americans finance and receive health care are still evolving (see Interview). This evolution presents traffic safety and injury prevention professionals with the challenge of learning to work with new partners and the opportunity of using financial incentives to make injury prevention part of the health care package offered to Americans by their health care providers.

Building Bridges Home Page

http://www.edc.org/HHD/csn/buildbridges/bb3.1/injprev.html
Revised: October 22, 1996

Š1997 Education Development Center, Inc.