Putting the “Care” in Managed Care

Putting the “Care” in Managed Care

Perspectives from our managed care team at AHF

GUEST BIO:

Julio Roberto is a medical social worker out of the Fort Lauderdale bureau. 

Karen Haughey is a registered nurse and Vice President of Managed Care, also based in Fort Lauderdale. 

Rebeca Rubio is the National Director of Managed Care Operations and Program Development based in Los Angeles.

CORE TOPICS + DETAILS:

[2:13] - Defining Managed Care at AHF

What they do and what it means

Managed care is a far-reaching term at AHF, including everything from providing support for people without a healthcare plan to offering integrated medication management and case management regardless of insurance status. 

The overall effect is greater patient care and satisfaction among a group of people who often come into AHF frightened and with no idea how to begin their journey. Managed care provides them with empathy and direction.

[8:04] - Day-to-Day with Patients

What managed care means on the ground

The managed care team’s goal is to soon have a representative available to speak to every single person who walks into an AHF healthcare center. This isn’t currently the norm nationwide among big box insurance companies. In AHF’s vision, everybody will get a care manager and a full team to ensure they get what they need, when they need it— all with a focus on empathy.

[12:20] - Working with Other AHF Business Lines

A culture of collaboration

Managed care works with nearly every line of business at the organization, from finance and IT to the healthcare centers themselves. For example, they work directly with healthcare centers as it relates to patients receiving bills or claims on the health insurance side. If a patient receives a bill, they can communicate with managed care about getting it processed for payment— and ensuring they don’t get surprise bills.

[17:31] - Final Thoughts

What AHF members and patients should know about the managed care team

Karen shares a common refrain she shares at managed care: 

“Managed care dances on the edge of all of our contracts, and our regulations, and the mission. When we fall, we always fall on the side of the mission."

The biggest takeaway is that managed care exists to make the mission of AHF— patient health— their personal mission. “When we collaborate on that, or put that together with the mission of AHF, everyone benefits.”

RESOURCES:

• [6:59] AHF Healthcare Centers

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ABOUT AFTER HOURS:

The AIDS Healthcare Foundation is the world’s largest HIV/AIDS service organization, operating in 45 countries globally. The mission? Providing cutting-edge medicine and advocacy for everyone, regardless of ability to pay.

The After Hours podcast is an official podcast of the AIDS Healthcare Foundation, in which host Lauren Hogan is joined by experts in a range of fields to educate, inform, and inspire listeners on topics that go far beyond medical information to cover leadership, creativity, and success. 

Learn more at: https://www.aidshealth.org

ABOUT THE HOST:

Lauren Hogan is the Associate Director of Communications for the AIDS Healthcare Foundation, and has been working in a series of roles with the Foundation since 2016. She’s passionate about increasing the public visibility of AIDS, the Foundation's critical work, and how everyday people can help join the fight to make cutting-edge medicine, treatment, and support available f