Managing Managed Care

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

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Reducing Diagnostic Errors is Cost-Effective

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Focusing on the quality of care is a "win:win" for both practitioner and patient.  The ideal setting in which to study this parameter of care along with cost-effectiveness and accessibility is the patient-centered medical home (PCMH) because the medical home is, by design, comprehensive and well-coordinated.  Furthemore, that is where one may best address safety issues such as diagnostic (Dx) errors (i.e., missed, delayed, or incorrect diagnoses). 

How to Increase the Value of a Medical Practice

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Improving communication and collaboration will get the clinical cost-benefit job done Recommendations for Payer-Practitioner Collaboration However, before discussing how to save money in health care, let's review price gouging in the good 'ol USA as presented by Ezra Klein in the Washington Post, March 15, 2013 writes: "Why an MRI costs $1,080 in America and $280 in France."  [It is all, still quite relevant]

The 4 Main Reasons We Fail Reforming Health Care: Cost Fears, Variation, Poor Collaboration and Understanding

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Approximately 2/5 persons don't understand their insurance coverage, i.e., which healthcare services are being covered under their current plan and, 1 in 5, "have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns."

When's "Good" Quality, Good Enough?

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"The current system is a mess because payment in the private sector is related to competition, contracts, etc. One gets paid a different amount by each. A single payer would have lower per episode payment, but would cover all and make billing simpler and more reliable." Leemore Dafny, PhD Harvard Business School Namita S.

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

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

Battling Cancer Beyond Everything

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It is crazy to deny terminal patients access to possibly life-saving drugs for fear of offending the Statistics gods! Whether for-profit or not, insurance companies and the pharmaceutical industries are weighing in on experimental therapies; we have to be sure that reasonable  interventions are given a reasonable chance, and that reasonable costs can be factored in. Quoting my wife who is a two-time cancer survivor and advocate:

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."

Data Science Strategy; the Managed Care Method

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Healthcare reform is really about managing the care so that it is optimally accessible, reasonable and reliable quality (esp. less variation), and is more efficient and cost-effective.  Here's what a fellow Medical Director and I wrote about this in 1994, still very relevant:

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