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 (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.

Enhancing HealthCare's Worth

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It's disheartening; the cure for the ills of U.S. health care lies within our grasp, yet it eludes us. We cannot answer basic questions–What works?  What we are paying for? Are we getting what we need?  Are we getting the right care at the right time and place? QI and UM: Strange bedfellows, but both need data to communicate

"Health Care" and "Insurance Companies"--Oxymoron

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"I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout 10/25/09) Isn't it frustrating to have to live under employment based health care insurance?  If you lose your job, your employer wants to cut back, or you are a peasant, you're screwed!  Also, as a result of the way we are paid and the insurance model itself, there are many forces today that steal us away from the exam table or bedside.

More for Less by Medicare

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Medicare is expected to consume 18% of the federal budget in 2020, 3% more than in 2010. Indeed, projections are that the Medicare trust fund (Part A) will be below water covering all the hospital bills by 2024.

Med School Doesn't Teach This

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What new docs need to know and never learned in medical or osteopathic school Harvard Medical School's Top Health Headlines of 2015 as reported in HEALTHbeat, on Twitter, and in their blog. (To read any of these articles or patient education pieces, please go to their website: www.health.harvard.edu/ and/or get a free subscription by registering there.)   Top 5 HEALTHbeat articles How stretching keeps your joints moving Exercise: An effective prescription for joint pain

Heart's Not Healthy? Recouping Tips

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When it comes to health, the better-informed patient does better—Duh! What is a patient to do to reverse or ameliorate heart failure, that is, besides taking meds? ABSTRACT Context Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system.

Real Reform

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The strategic agenda for real reform lies in creating a value-based health care delivery system. As stipulated by Porter and Lee in 2013, health care will be organized and paid for differently in the near future.  Six critical steps in reform as as follows [modified]: Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work);

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. A fellow Medical Director and I wrote in 1994:

Waste Less; Add Value

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To make health care reasonably profitable for private payers and more affordable for patients, those who manage health care must focus on reducing cost, which is far easier than increasing the health benefit or medical loss ratio.

Race to Health Info Tech--Tortoise or Hare?

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"Providers Believe Healthcare Reform will Increase Their Costs."  Here follow a few of its responses: 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. 

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