Managing Managed Care

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

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The Managed Care Method

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Predicting health care costs and benefits 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. A fellow Medical Director and I wrote in 1994:

Doctoring All Of Health Care At Once

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The U.S. practices of medicine and surgery aren't as cost-effective as other countries. We suffer intolerable costs (poor value) and huge variation in our practices, the way we fail to coordinate care and communicate, health care reform is vital.   Caveat: The means to a desired end–A truly integrated electronic medical record with acuity or case-mix assessment, point-of-service alerts and patient tracking (process and outcome) is necessary. Why are we not doing the right thing?

Race to Health Info Tech--Tortoise or Hare?

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"Providers Believe Healthcare Reform will Increase Their Costs."  Here follow a few related comments and stats: 61% believe "electronic health records (EHRs) could have a positive impact on their businesses" 82% cited their biggest challenge in implementing HlT is cost. 17% of providers are or are planning to participate in a Health Information Exchange (HIE) over the next 12 months.

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 medical loss ratio). 

The Business Opportunity of Medicine

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The practice is getting squeezed; Want ideas? First, don't give up on the idea that small practices are out.  Consider them, if for no other reason then they are often better then large pracices that are overly driven to see large volumes of patients. IOW, solo and small practices are still playing an important role, although they may require TLC to thrive.

Rethinking Cancer

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Cancer; Just who invited you? Many cases of cancer are just caused by "bad luck" as two scientists "suggested in an article published last week in the journal Science. The bad luck comes in the form of random genetic mistakes, or mutations, that happen when healthy cells divide."  

Physician Compensation

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Reform will fail when practitioners are not getting paid for legitimate work they do. Paying healthcare practitioners fairly is the crux of healthcare payment reform.  Here is a brief synopsis of how methods to reign in physician compensation have always failed and nothing was ever solved through cost-shifting or cost-sharing. In brief, various attempts "Reforming Medicare's Physician Payment System" [N Eng J Med] have fallen flat.

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