Managing Managed Care

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

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The Best Diet

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Six Cardinal Rules when attempting to lose weight and/or reduce the risk of heart and other diseases You MUST take in (eat) less calories than you burn (by exercising and being active) Portion size must be reasonable; do not eat to satiety; try to eat a fair amount of whole grains, fruits, and vegetables, but consume Eat fewer carbohydrates, especially refined and high sugar-loaded ones. Enjoy more polyunsaturated fats (e.g., plant oils and fish). Veer away from low-fat dairy products and nuts.

The EHR—on the Road Where a Cottage Industry Lived

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Improving doctors' quality, effectiveness and cost-benefit requires meaningful communication at all levels and settings. To cure health care's ills, there's an obvious remedy that is difficult, but not impossible to implement—make cogent information* available at the point of contact with the patient, regardless of setting and within HIPAA constraints.   

Waste Less; Add Value

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To make health care reasonably profitable for private payers and more affordable for patients, those who are responsible for managing the care must concentrate on reducing cost (which, by the way, is far easier than increasing the health benefit or favorably affecting the medical loss ratio). 

Specialist Surfeit; Primary Care Paucity

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It's schadenfreude (enjoyment obtained from the troubles of others).  That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs. As Dr. Pauline W. Chen said in "Where Have All the Doctors Gone?"—"I [don’t] envy Mr. Obama.... Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system."

"But, My Patients Are Sicker!"

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Clearly, practitioners could help improve the value of care by reducing variation in practice, a sentinel for quality.  They also could help eliminate waste and duplication, thereby improving efficiency, cost-effectiveness and even clinical outcomes (i.e., benefit).  That effort may include, but should not be limited to having integrated systems of care, shared savings, bundled payments, or global fees and performance measures that promote care coordination.

Affordable Care's in Watch Mode

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Who's not anxious to improve health care's Cost/Quality/Access, lest they be left out?  Ans: anyone but concierge practitioners, i.e.,all the rest of us–hospitals, insurance companies, health care workers and drug and medical device manufacturers. The hospital association, for instance is one of six groups that went to the White House on May 11, 2009 to announce they have made a commitment to accountable care with quality, accessibility and reasonable cost as its mainstay.

Healthcare Reform in the U.S.

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The United States is the only wealthy, industrialized country that does not ensure that all of its citizens have healthcare coverage. Insuring America's Health: Principles and Recommendations, Institute of Medicine at the National Academies of Science, January 14, 2004, last accessed Tuesday, February 2, 2010

The Nexus of Quality and Cost

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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, the only thing that has worked is raising the pric

Changing How Medicine's Practiced

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The Bio-Psycho-Social, Collaborative Model of Healthcare "It is possible to screen for and treat depression in the primary care setting. Collaborative care for depression can succeed in diverse settings with a range of staffing combinations, patient demographics, and physical layouts. Centralized data support is essential to drive operational workflows and quality improvement across multiple sites."

When Practitioners Collaborate, It Can Clinically Help, Financially Hurt or Both

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Is it the patient's fault when they end up getting needed care out-of-network, i.e., from physicians who aren't part of the managed care network, the referral list is too thin or restrictive, the right specialist is elsewhere (or so it seems), or simply because there was no opportunity to choose an in-network doctor? Referrals Tell Us a Great Deal About Collaboration Among Practitioners

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