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The Role of Managed Care in Identifying and Counseling Patients With Prediabetes
John A. Johnson, MD, MBA: In the managed care community, what we’ve seen in the United States is a growing incidence and prevalence of obesity and Americans who are overweight. Obesity, being overweight, and inactivity are all risk factors for developing diabetes. So is low social economic status—whether it’s low-income or low-educational background.
So, managed care likes to partner with community entities. For example, at WellCare, we partner with agencies to host health fairs. We do this to screen the general public and enhance awareness of diabetes.
Twenty-nine million Americans have diabetes, 25% of them are unaware that they have diabetes, and 86 million Americans are pre-diabetic. The more of those Americans that we can screen and find the diagnoses, the more we can avoid some of the downstream complications.
The managed care organization partners with providers to ensure that patients receive a BMI (body mass index), and to determine an exercise regimen, and to counsel regarding nutrition to help ensure that they are less likely to develop diabetes by becoming more active and managing their diet.
In managed care, it’s really more of a partnership to prevent the onset of diabetes with earlier screening and earlier intervention. At WellCare, we do that by partnering with agencies that help us.
AI in Health Care: Closing the Revenue Cycle Gap
April 1st 2025This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.
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Managed Care Reflections: A Q&A With Hoangmai H. Pham, MD, MPH
April 1st 2025To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).
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Bridging Care Gaps With a Systemwide Value-Based Care Strategy
March 29th 2025Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.
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