IFRS Foundation

Managed Care

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Current language: English
The Managed Care industry offers health insurance products for individual, commercial, Medicare and Medicaid members. Entities also provide administrative services and network access for self-funded insurance plans and manage pharmacy benefits. Enrolment in managed care traditionally has been correlated with employment rates, whereas revenue is driven by medical cost inflation. Legislative uncertainty and a focus on reducing health care costs may create downward pricing pressure and continue to drive industry consolidation. In addition, a focus on patient outcomes and plan performance continues to shape the industry’s sustainability risks and opportunities.

Relevant Issues (5 of 26)

Why are some issues greyed out? The SASB Standards vary by industry based on the different sustainability-related risks and opportunities within an industry. The issues in grey were not identified during the standard-setting process as the most likely to be useful to investors, so they are not included in the Standard. Over time, as the ISSB continues to receive market feedback, some issues may be added or removed from the Standard. Each company determines which sustainability-related risks and opportunities are relevant to its business. The Standard is designed for the typical company in an industry, but individual companies may choose to report on different sustainability-related risks and opportunities based on their unique business model.

Disclosure Topics

What is the relationship between General Issue Category and Disclosure Topics? The General Issue Category is an industry-agnostic version of the Disclosure Topics that appear in each SASB Standard. Disclosure topics represent the industry-specific impacts of General Issue Categories. The industry-specific Disclosure Topics ensure each SASB Standard is tailored to the industry, while the General Issue Categories enable comparability across industries. For example, Health & Nutrition is a disclosure topic in the Non-Alcoholic Beverages industry, representing an industry-specific measure of the general issue of Customer Welfare. The issue of Customer Welfare, however, manifests as the Counterfeit Drugs disclosure topic in the Biotechnology & Pharmaceuticals industry.
General Issue Category
(Industry agnostic)

Disclosure Topics (Industry specific) for: Managed Care

Data Security
  • Customer Privacy & Technology Standards

    Regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) in the U.S., may require health insurance plans to comply with various requirements relating to the use, disclosure, storage, and transmission of patient health information. Entities in this industry are required to develop policies and technical safeguards to protect patient health information. A failure to comply with these evolving standards, which in the U.S. include provisions established under the Health Information Technology for Economic and Clinical Health (HITECH) Act, can lead to significant civil and criminal penalties. These risks are intensified by an increase in cyberattacks that target managed care entities.
Access & Affordability
  • Access to Coverage

    Although the Patient Protection and Affordable Care Act in the U.S. reduced the number of uninsured, more than 10 percent of adults in the United States remain uninsured. The percentage of uninsured is significantly higher for people near or at the federal poverty level. Managed care entities can play a role in providing additional access by limiting plan costs and rate increases. Entities must also comply with regulations intended to control plan costs, including medical loss rations, while also ensuring coverage for all applicants regardless of health status, gender, or pre-existing conditions. Increased regulatory focus on health care costs and the need to comply with evolving regulations continue to present challenges for the industry.
Product Quality & Safety
  • Plan Performance

    Managed care entities manage performance in areas such as responsiveness, complaints, voluntary disenrollment, and customer service in order to maintain competitiveness. Under the Five-Star Quality Rating System for Medicare Advantage Plans in the U.S., performance on key metrics are factored into federal reimbursement rates and bonus payments for Medicare Advantage carriers. Disclosure on key indicators related to plan performance may allow shareholders to understand how managed care entities are able to protect corporate value.
Customer Welfare
  • Improved Outcomes

    Managed care entities can play a critical role in maintaining and improving the health of enrollees. In addition, legislation continues to emphasise improved outcomes through provisions, including those that require health plans to provide coverage for preventive services without cost to members. The development of the Five-Star Quality Rating System for Medicare Advantage Plans in the U.S., for example, further strengthens the relationship between enrollee health and value by linking reimbursement rates and bonus payments to performance in five domains, including specific outcome-based measures. Entities that are able to improve the health of enrollees may be better positioned to protect shareholder value.
Physical Impacts of Climate Change
  • Climate Change Impacts on Human Health

    An increase in extreme weather events associated with climate change could have significant health impacts. These events, coupled with the potential spread of infectious diseases and food and water scarcity, may present material implications for the Managed Care industry through an increase in encounters with the health care system. Entities that manage the risks posed by extreme weather events and potential changes in the incidence, morbidity and mortality of illnesses and diseases may protect shareholder value better.

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Current Industry: Managed Care

Health Care
Consumer Goods
Extractives & Minerals Processing
Food & Beverage
Renewable Resources & Alternative Energy
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