Managing Managed Care

Our inequitable, inefficient, oftentimes uncaring health care "system," revealed. -- Jeffrey G. Kaplan, M.D., M.S.

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Debit Cards and How They Explain the Costs of Care

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If you are in a concierge medical practice or you are a specialist, you can stop reading.  But, if you aren't and are concerned about the pressure to reduce the costs of care while not compromising accessibility or the quality of care, then understand the incentives matter critically to you; ignore that and you will pay dearly. Perhaps you feel how the insurers pay you is what it is and you'll deal with it.

Improve Healthcare's Value or It's Not Affordable

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The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., affordability. You can increase value by raising quality, improving accessibility and by lowering the cost of care. The "cost of care," however, is the elephant in the room.    

Wrong Priorities

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Witness the outrageous 20-30% administrative overhead of medical insurance companies.... That includes a covert and obnoxious 'cost-savings-is-more-important-than-patient-care' reward system.  This is even true for non-profits.  It's the difference between medical business and the business of medicine—taking care of patients or profit$. 

Effective care trumped by less costly care

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Pet Peeves: antibiotics for short term, ostensibly viral diseases -- bronchitis, sinusitis, nasopharyngitis or otitis media; half of abdominal CT scans or the half of back MRIs that show bulging disks on persons sans back pain. Who's failure is it to not control costs? Ref.: Chen P. "The Doctor’s Failure to Cut Costs" NY Times March 3, 2010 (Extracts are for discussion purposes, only) In an editorial in The New England Journal of Medicine, Dr.

Insurers--Get With the Program!

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President Obama champions three goals for reform: 1) "increasing security and stability" and "shared responsibility" for coverage for those having insurance, for the uninsured, 2) giving all “quality, affordable choices,” and the sticky widget, 3) "slowing the growth of health care costs." His plan would strike at the sinister 'heart' of private insurers and their sickening stratagem of: denying coverage because of "preexisting conditions, dropping or reducing coverage when an enrollee becomes i

Asthma Control

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In poorly controlled asthmatic children, what works best? Ans: Long-acting beta agonists (the ones with the warning*) are more effective than either monteleukast (Singulair) or doubled dosing inhaled corticosteroids.

Manager's Choice: LinkedIn's MCO Executives--Healthcare Reform Will Fail if We Do not Reduce Costs!

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The question really is what are you getting for your health care dollar?  What's right or not right with the healthcare system, and why? And, what specifically needs to be changed and how will that be accomplished, if at all?   The "Bang for the buck" issue is the Medical Loss Ratio. I am revisiting it from a previous publication, "Healthcare Reform Will Fail if We Don’t Reduce Costs!" that had appeared in

The Managed Care-Pharma Interface-Part II: the Tension

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Clearly, the interface between managed care and the Pharmaceutical and Medicine Manufacturing (PMM) industries, is important for the health of either industry.  In common tare he issues of appropriateness, compliance, cost-effectiveness, patient selection and symbiosis among all relevant players on the health care stage (ACCESS). I say, put the practicing clinician on the PMM team and visa versa—How and Why?