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

    Applicable jurisdictional laws or regulations may establish various data security requirements relating to the use, disclosure, storage and transmission of patient health information. Entities are required to develop policies and technical safeguards to protect patient health information. A failure to comply with these standards 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

    Entities in the Managed Care industry may improve a population’s access to health care by limiting plan costs and rate increases for health insurance in jurisdictions where private health insurance is prevalent. These improvements most significantly affect segments of the population that tend to have lower rates of insurance coverage. These entities generally must also comply with regulations intended to control plan costs, including medical loss ratios, as well as ensuring all applicants have access to coverage regardless of health status, gender or pre-existing conditions. Increased regulatory focus on health care costs and compliance 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 to maintain competitiveness. In some jurisdictions, performance on important metrics may be factored into reimbursement rates and bonus payments. Disclosure on specific indicators related to plan performance may allow investors to understand how entities protect enterprise value.
Customer Welfare
  • Improved Outcomes

    Entities in the Managed Care industry can play a critical role in maintaining and improving the health of enrolees. Improved enrolee health can help entities develop a reputation for high-quality care, potentially leading to increased market share and improved margins. Some entities may participate in programmes that try to strengthen the relationship between enrolee health and entity value by linking employee performance to reimbursement rates and bonuses. Entities that take part in such programmes may develop a competitive advantage compared to those that do not. Entities that fail to deliver high-quality outcomes for enrolees may experience decreased market share, penalties such as fines and suspensions, and increased legal costs.
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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Managed Care
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