Understanding wireless door-bell video technology may by its purpose and effect provide recognizable structural components for utilizing management technology to reduce cost, monitor current status, coordinate other overall management components, minimize bad outcomes and prevent catastrophic results. This is also the definition of chronic care management actually with a profound cross over of technology applications. Even trying to use managed care and long term care in a meaningful context can be very confusing. It remains difficult to isolate the meaning of “managed care.” All levels of care are available and frankly in desperate need of efficiency management—acute, sub-acute and custodial. Therefore you must start with the degree of care you are attempting to make more time efficient and humanly personal all at the same time. Let’s begin by throwing all aspects of medical/social technology into the massive boiling cauldron of managed care. Nothing better defines our humanity than unpredictable mortality and the persistent need for morbidity care management from infants to the infirm. This column would not be on point without the conversation being framed by who or whom shall control that precious care management. When, where, how and under what circumstances that care will be provided, funded and managed is long term care.

  • Perhaps it is best to begin at the source of the need for amelioration efficiencies—chronic disease! Chronic health is defined as a serious physical or mental condition that lasts one year or more. This includes conditions of heart disease, cancer, diabetes, substance abuse, lung disease, and a plethora of additional debilitating conditions. Six in 10 American adults have a chronic disease and four in 10 have two or more. It should therefore not come as any surprise that the pipeline for extended custodial care is always full.
  • Efforts to improve the performance of integrated health care services have been slowly but surely developing since the introduction of H.R. 337 Managed Care Consumer Protection Act of 1997. Although this legislation did not pass, it began a process of gradual state implementation that now includes a majority of states. Before we get too far off in the weeds let me take a shot at explaining what is a very complicated and regulated state/federal government attempt to better coordinate the care needs of, for the most part, dual eligible individuals—those qualifying for Medicare and Medicaid. I would only ask that you understand this program does include custodial care issues but is not its primary focus. These are not our customers for insurance. There are however some important care focus similarities that have application in our long term care insurance wheelhouse:
    • The participants must be engaged and personally involved in their care plans.
    • These managed care options must be strongly encouraged to take place at home.
    • The clinician must facilitate a holistic approach to the patients care to include mind, body and spirit.
    • The participant is allowed to choose the level of intrusion and control they are willing to accept.

Principles of managed care in some states such as New York may be specific to long term care. These again are not our customers, however the use of technology to increase the frequency of interactions and the integrated coordination of various support mechanisms may clearly provide us with insights into better serving the quality of care being delivered at the time of claim management. The important lesson here is that research into the efficacy of these support programs does indicate that they improve the quality of care options and save money.

Understanding the background and undercurrents of today’s efforts to manage care both to improve the quality and efficiency of that care and in the process reduce cost is the most important door bell guarding the entrance to all our insurance futures.

Other than that I have no opinion on the subject.

Ronald R. Hagelman, CLTC, CSA, LTCP, has been a teacher, cattle rancher, agent, brokerage general agent, corporate consultant and home office executive. As a consultant he has created numerous individual and group insurance products.

A nationally recognized motivational speaker, Hagelman has served on the LIMRA, Society of Actuaries, and ILTCI committees. He is past president of the American Association for Long Term Care Insurance and continues to work with LTCI company advisory boards. He remains a contributing “friend” of the SOA LTCI Section Council and the SOA Future of LTCI committee. Hagelman and his partner Barry J. Fisher are principles of Ice Floe Consulting, providing consulting services for Chronic Illness/LTC product development and brokerage distribution strategies.

Hagelman can be reached at Ice Floe Consulting, 156 N. Solms Rd., New Braunfels, TX 78132 Telephone: 830-620-4066. Email: