Managing Managed Care

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

Med. Newsletter / eBook

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Reform Issues

Discouraging Care

Clearly, FFS is history–been there; done that! Fixing health care 101 Read more Tags: fee for service, capitation, prospective payment, at risk, coordinate care, quality, cost, access Read more articles about: barriers to care

Accountable Care's in Watch Mode

Who's not anxious to excel at cost-cutting, care coordination and quality, lest they be left out? Read more Tags: accountable care organization, collaborative, coordinated care, cost cutting, cost-cutting, readmission, Medical Error, information technology, chronic disease, standardized claim forms, health spending Read more articles about: Reform Issues

The "areas in which the proper reform measures could generate savings that could pay for universal coverage" include, but are not limited to unecessary and presumably unhelpful care, fraud and from the perspective of the physician, extraneous administrative expenses. Read more Tags: Fiscal Responsibility, URI, sinusitis, unwarranted variation, health care reform, physicians’ income, unnecessary care, universal coverage Read more articles about: Reform Issues

Changing the Way Medicine Is Practiced

A Painless Way To Hold Down Health Costs? Read more Tags: costs and cost analysis, decision making, guidelines, patient satisfaction, patient-physician relationship, personal autonomy, quality of health care, unnecessary procedures unnecessary care, non-beneficial Read more articles about: quality, cost and/or access

Opportunity for Real Reform

The confluence of a exacerbated health care crisis and a Presidential reelection created opportunity for change, but Robert H. Brook, MD, ScD of the Rand Corporation, a non-profit think tank, warns that simultaneously improving health care coverage, the affordability of health care and its quality will be difficult. Read more Tags: fee-for-service, fee for service, payment reform, FFS, SGR, RVS, RUC, inappropriate care, unnecessary care, unnecessary services, spending, benefit, Luft, Brook, The Science of Health Care Reform, non-discretionary, care, cost-sharing, cost sharing, cost-shifting, cost shifting Read more articles about: barriers to care

Quality of Care--When is "Good," Good Enough?

Quality of Care--How Good Is Good Enough? Read more Tags: quality of care, maximize patient welfare, quality, access, cost-efficiency, spending, affordability, cost-effective, charge, pricing, price disparities, optimal care, advocacy, outcomes, health insurer, premium, meaningful information, measurement, management, outcome, benefit, value, value equation, shell game Read more articles about: quality, cost and/or access

The Nexus of Quality and Cost

The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment. Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments. When it comes to lifestyle management, we fail, miserably. For instance, getting people to stop smoking... Read more Tags: quality improvement, value, value equation, medical expenditure, cost, quality, access, the elephant in the room, spending, health care reform, affordability Read more articles about: quality, cost and/or access

Cost is the Big Item in the Value Equation of Health Care and Here's Why

The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., affordability. To increase "value," one must raise quality, improve access and/or lower the cost of care. The latter, however, is an elusive goal; it is the elephant in the room. Read more Tags: quality, access, cost-efficiency, spending, affordability, cost-effective, charge, pricing, price disparities, optimal care, advocacy, outcomes, health insurer, premium, meaningful information, measurement, management, outcome, benefit, value, value equation, shell game Read more articles about: value

Primary Care or Specialist--Piecework Pays Better; Costs More

Specialists fractionalize care; that's costly; In the medical home, primary care treats the whole patient. To explain the drastic shift needed to encourage primary care and discourage a further and unjustified overabundance of specialists, know that: Read more Tags: waiting times, non-emergent appointment Read more articles about: quality, cost and/or access

Ignorance is Bliss

The electronic health or medical record (EHR/EMR) boils down to data that are intended to be more complete, accurate and available, yet it often does not improve communication and information flow. To get the most out of the technology, doctors actually have to, you know, use it. To get docs to use, it, thre must be meaningful use.* Read more Tags: EHR, electronic health record, reminder, alert, follow through Read more articles about: communication/knowledge