The modus operandi in managing care is that 'one cannot manage what one does not measure and the obverse, one cannot measure what one does not manage.' Consider the final equalizer in health care method comparisons—outcomes….who's measuring? Who's managing?
To paraphrase Peter Drucker, you cannot manage what you don't measure and you cannot measure what you don't manage. The private sector is not and will not be the best positioned to control the quality, cost and access of health care. The mandate gets most of us into the risk pool. For those who don't need vouchers, there's a tax for not being a player. Thus, we are moving to Universal care - health care as a "right." Today's iteration of the managed care organization (MCO), the accountable care organization (ACO) encompasses and integrates all the patient care settings: hospital, primary care physician (PCP)/medical home, specialty and ancillary care to a salutary place where the focus is on the patient, not shareholders, Big Pharma misrepresentation or obscene insurer profit. It is in that comfy place where the patient and their family's medical intervention, if not prevention health care needs can best be met, And it is also here where the incentives can be properly aligned, even the patient's need to be accountable for continued adverse lifestyle choices.
Done right, I, as a practitioner should make more if I help patients better, if I practice within a reasonable standard, efficiently, cost-effectively and effectively. The obverse is that if I churn, over utilize, over refer, fractionate the care, have a high preventable hospitalization rate, etc., I should make less. When the incentives are properly aligned, "for profit health care" becomes an oxymoron; medical loss ratios simply guarantee 'patient before profit,' and the gross disparity of earnings, PCP to specialist diminishes allowing primary care supply to meet the demand for appropriate, timely care.
Now the point of this mini-diatribe - you need a central authority where tons of disparate data can translated into bite-sized information pieces like episodes of care. Such information must be acuity-adjusted and grouped so that the processes and outcomes of care can be accessed--who did what? where? when? and assessed--where's be best cost-benefit? the best cost-utility? The role of management defined this way calls for Single Payer, a currently unachievable, large penetration, stable patient population ACO, or a matrix organization. I still feel insurance companies are best suited to be the latter type of player.
One caveat however—don't be fooled about pseudo measurement of outcomes, biased (predjudiced) studies or self serving research 'conclusions.' Before mentioning personal references on the related subject of "Measurement and Management," beyond what you can find here — 22 hits on "Measure and Manage" and slightly less on "Measurement and Management" — and below, please look up a really great book: "Why Nobody Believes the Numbers; Distinguishing Fact form Fiction." by Al Lewis
Pub. John Wiley & Sons, Inc. © 2012 ISBN 978-1-118-31318-3 (hardback); ISBN 978-1-118-33536-9 (ebk); ISBN 978-1-118-33420-1
‘‘Why Nobody Believes the Numbers exposes the poor design and invalid statistics of disease-management programs in a credible, user-friendly fashion. The case studies and mathematical proofs show readers how to identify and address outcome measurement malpractice. Its entertaining style can keep readers’ interest long after they might otherwise have closed the book on the statistical fallacies of study design.’’
—Nancy Kane Professor of Management and Associate Dean for Educational Programs, Harvard School of Public Health