Dr. Mark Rosenberg

Director, National Center for Injury Prevention and Control

From Spring 1996
Volume III, Number 1

Building Bridges was fortunate enough to be granted interviews with Dr. Mark Rosenberg, Director, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention (CDC), and Dr. Ricardo Martinez, Administrator, National Highway Traffic Safety Administration (NHTSA). These excerpts touch on the implications of managed care for traffic safety and injury prevention.

There are many opportunities for managed care organizations to become involved in injury prevention. There are many proven interventions with high benefit-cost ratios. The trick is figuring out how these interventions can be utilized by managed care organizations.

For example, managed care organizations pay a large part of the $12 billion in hospital and rehabilitation costs due to motor vehicle-related injuries. A substantial portion of these injuries are related to alcohol abuse. Alcohol is also associated with drownings, burns, suicide, and interpersonal violence. To prevent alcohol-related injuries, managed care organizations can screen injured patients for alcohol problems and provide counseling and other treatment services as needed. This can help improve patient management and reduce the risk of future injuries and deaths.

Managed care organizations are also in the position to intervene when subscribers develop medical conditions that affect their driving ability-conditions like strokes, seizures, or impaired vision. Capitation [a system under which the health care provider receives a fixed fee for each person under their care, regardless of the actual cost of treatment] provides a vested interest in keeping people healthy-and a new reason for physicians and health care organizations to intervene when they believe patients' driving abilities may be impaired.

Some of these interventions will not pay off in the short run. But they pay off very well in the long run. The more managed care organizations promote health and prevent injuries, the more satisfied their clients will be. They will also be less likely to drop out and go to another health care organization. I think people will remain [in a particular health plan] for a longer period of time if you provide an image that shows you care-by distributing bicycle helmets, for example. This may increase their incentive to stay with you. That's another reason to look at issues such as preventing domestic violence, youth violence, motor vehicle injuries, falls, fires and burns, and sports-related injuries. All these activities promote the image of the managed care organization as responsible and caring. In addition, investment in injury prevention programs might help managed care organizations market themselves to benefits managers and others who make health care purchasing decisions.

We need to look at the greater good and how the system could work if everyone paid attention to the common good-not just their strict share of the market, not just their members at this point in time. If every managed care organization provides helmets for children, then kids throughout the country will have helmets, and kids moving into a different managed care plan will come with their helmets. Thus, the burden of shared costs for head injuries for all managed care organizations will decrease.

Another reason to become involved in injury prevention is the good it does for an organization's subscribers and the community in general. And doing good is something that the members of the managed care organization-the physicians, the nurses and technicians, as well as the patients-really care about. There are many managed care executives who want to do good things. Some managed care organizations are investing for altruistic reasons right now-trying new approaches and funding programs through a foundation or pilot interventions. They have concerns that go beyond the profit margin and beyond the individual client.

Managed care organizations are still evolving. We're still in the early stages. We can't expect that managed care organizations will assume all of the responsibilities traditionally held by traffic safety and public health agencies. There will be a process of mutual education. There are things that each can teach and things that each can learn.

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Revised: October 22, 1996

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