A broader vision for managed care, Part 1: Measuring the benefit to communities.

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Abstract
PROLOGUE: Managed care plans are nicely positioned to influence communities in ways that extend well beyond the provision of health care services. With their vested interest in keeping populations healthy, they have contributed to a growing focus on addressing the social and economic factors that affect community health. This paper by Mark Schlesinger and Brad Gray asks whether a community benefit standard should be imposed in the managed care industry as a measure of plans' contribution to local communities. The authors suggest that although there are a number of indications that managed care has embraced the concept of community benefit, the future of plans' participation in communities—particularly their participation in providing safety-net services—is precarious. Without explicit incentives to make measurable contributions to the communities in which they operate, managed care organizations will serve the health care needs of their enrollees but will not necessarily define a broader community role for themselves. Schlesinger and Gray look at the evolution of the concept of community benefit and at the dynamics that have contributed to its increasing importance and its increasing fragility as a health policy issue. Schlesinger, who holds a doctorate in economics, is an associate professor of public health and a fellow of the Institution for Social and Policy Studies at Yale University. Gray, who holds a doctorate in sociology, is director of the Division of Health and Science Policy at the New York Academy of Medicine. This is the first paper in a two-part series; the second part will be published in Health Affairs later this year. For the past quarter-century managed care plans have been judged almost exclusively in terms of their influence on the health and health care of individual enrollees. However, policymakers are now paying attention to the ways in which health care organizations affect the broader well-being of their communities. These forms of “community benefit” emerged originally from legal criteria for tax exemption but are increasingly applied to all health care organizations, whatever their form of ownership. In this paper we identify different paradigms for defining community benefit and trace the factors that have encouraged or discouraged their application to health care. We suggest several strategies encouraging managed care plans to broaden their goals to include community benefit.