Managing Managed Care

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

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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. Whose failure is it to not control costs? Ref.: Chen P. "The Doctor’s Failure to Cut Costs" NY Times 3/3/2010 (Extracts are for discussion purposes, only) In an editorial in The New England Journal of Medicine, Dr.

Healthcare Reform/Economic Imperative

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Is health care reform merely cost-minimization, an opaque attempt to force economic responsibility? Simplifed, Here's the essence of health care reform and how to restore equity in access.... 1)    To reform care we must manage the care a)   The fact that delivery models vary or that they are evolving should not distract us from our goal to have effective care that is efficient and thereby cost-effective.  At the end of the day, however, it must be about the patient!

Pay More; Get Less

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The health insurance and managed care industries are strange bedfellows.  Now learn what is meant by health insurance: it works better for health insurance companies than it does for patients, by and large. They, the insurers "like to cite figures showing that 87 cents of every dollar in premiums is spent on medical claims. But a new Senate analysis suggests that for-profit insurance companies are spending much less than that, especially for policies sold to individuals and small businesses.

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

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

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A payer judges a physician or a practice organization by the proportion of patients for which the physician adhered to one or more practice measures. Those in quality measurement seem to be attempting to align the clinical quality measures that are relevant to the Electronic (EHR) Incentive Program.  Isn't that artificial and once removed from the patient's care?

Care Mgm't, Communication Curriculum Tools and Diagnostic Coding

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Coding systems that support clinical decision-making, 'measurement and management,' communication, especially about transitions of care and outcomes (acuity-adjusted) become the modus operandi of the new Managed Care.

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 (exercise and by 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 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.

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