Managing Managed Care

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

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Cost-Share or Measure and Manage

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The modus operandi in managed care is that one cannot manage what one does not measure. Outcome Measurement will be telling; it will be the final arbiter. Managed Care is a system of health care management that is intended to reduce inappropriate and/or unnecessary health care expenditures by aligning economic incentives for both practitioners and patients so that both understand their options and select care that provides optimal value.*    

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.

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?

Fear of Death--A Salient Quote and Approach

Tue, 2015-07-07 15:18 -- fitdoc
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"Perhaps the best cure for the fear of death is to reflect that life has a beginning as well as an end. There was a time when you were not: that gives us no concern. Why then should it trouble us that a time will come when we shall cease to be?  To die is only to be as we were before we were born." – William Hazlitt, essayist (1778-1830) Quote from The Conversation Project by Ellen Goodman and Others

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.

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