Identity Crisis: What’s in a name?

By Clive Riddle, February 12, 2009

I recently watched with bemusement as a stream of e-mails progressed through my inbox from participants in the HFMA Managed Care Forum debating what to change the name of their forum to, given the evolution of the business and the negative connotations of the term ‘managed care.’

The debate isn’t new. Significant Managed Care backlash in the media, consumer and provider community started ten years ago, and calls to re-coin the term have been continual ever since. The term “Health Plan” is often now inserted where Managed Care once resided for various publications, organizations and activities, but “Health Plan” doesn’t always fit the situation.

HMO’s aren’t so much the term of choice either, compared to a decade ago, given the decline in HMO enrollment and rise of PPO enrollment and other benefit designs. Back in the day (way back in the day) before “Managed Care” was coined, in the 1970’s the movement was often referred to as “Alternative Delivery Systems.” Eventually that term took on other meanings.

Even before Managed Care really hit backlash mode, there were calls to rename the term. CMS among other made a major effort to re-label Managed Care as “Coordinated Care.” Of course, back then CMS wasn’t CMS either. The Centers for Medicare and Medicaid Services was called HCFA (Health Care Finance Administration.) While we’re digressing, what’s up with the acronym CMS anyway? Why isn’t it CMMS? And which “M” stayed in, and which “M” got dropped? Is it the same reason that the Department of Health and Human Services some time ago dropped the “D” from DHHS and now call themselves HHS? Did the missing “D” and missing “M” get together and form the acronym for “Disease Management”?

Managed Care isn’t the only term, movement or industry continuing to experience an identity crisis. Consumer driven care is also referred to as consumer-directed care, and at the start of the decade “defined contribution health plans” was the term of choice referring to account-based plans. Of course, now many simply use the term “consumerism” to more globally encompass consumer driven initiatives, including those beyond the scope of account based plans.

Health care companies as well run into identity crisis as times change and situations evolve. Almost everyone knows that Kaiser Permanente after World War II grew out of Henry J Kaiser’s prior programs to provide prepaid clinics and care to his shipyard and steel workers. Not everyone knows that AvMed Health Plan of Florida was coined from “Aviation Medicine” when the company was formed in 1969 to provide a prepaid health system for the Miami area aviation industry.

Of course, if your first name is Clive, you’re used to identity issues. I have credit cards made out to Olive, phone calls for Cleve and Clyde and receive mail for Cline and Cliff. When I was in second grade I informed my teacher on the first day of class my correct name was Edward (my middle name) causing great confusion when I brought school friends home. Eventually I embraced my inner Clive. Clive Owens has made things a little easier, but its still an issue. Perhaps I should seek a Clive Forum and start a discussion thread on renaming the Forum. Perhaps I’ll check with the HFMA Managed Care Forum and see how things worked out for them.