Managing Managed Care

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

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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! Sent by Harvey Frey, MD, PhD, Esq.  Nov 2, 2013 11:50 PMSubject: [Dialog] How Dying Patients Get Access to Experimental Drugs

The Real Cost of Not Immunizing

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Measles is back and people will be getting ill, harmed or worse because someone is refusing immunizations. OTOH, routine childhood immunizations may reduce the risk of leukemia. [1]

Who's the Keeper of the Commons?

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What is our social responsibility? Who's ruining health care? Learn from a professor of biology: herders, not out of greed, but out of practical necessity graze more cattle than the finite, common land can support, ruining it for everyone. This exploitation is analogous to what happens when incentives are not aligned in health care: payers, practitioners and patients are doing what they feel they must without accountability for equity in access, cost-effectiveness, benefit or cost-utility.

Real Reform

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Health Care Will Be Organized (and Paid For) Differently Say Porter and Lee in the Harvard Business Review (Oct. 2013) The strategic agenda for real reform lies in creating a value-based health care delivery system. As stipulated by Porter and Lee, 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);

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.