Managing Managed Care

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

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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

Waste

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"Up to 30% of Medicare spending is wasted on needless care." "After adjusting for differences in health, income, medical price and other factors, the Dartmouth researchers’ overall conclusion is that the more costly areas and institutions provide a lot more tests, services and intensive hospital-based care than the lower cost centers. Yet their patients fare no better and often fare worse because they suffer from the over-treatment."

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!

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 (by exercising and 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 Eat 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.

Billing Beyond Customary

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Your health plan or doctor's office seems to see your heart attack, broken leg or laceration differently than you do.  They may want you to pay for that which one would ordinarily believe is covered.  In general, that is what consumer advocate, Ralph Nader calls "The Crime of Overbilling Healthcare." [Pub online August 31, 2014]

When's "Good" Quality, 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 abstract practice measures. Those in quality measurement seem to be attempting to align the clinical quality measures that are relevant to Electronic (EHR) Incentive Programs.  Isn't that artificial and once removed from the patient's care?

Patient-Centered Caring

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Achieving patient-centered care is difficult, but essential; since paternalism is out, the patient has a greater role to play. The editorial, "Patient-Centered Care; What Is the Best Measuring Stick?" by Drs.

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:

Prevent 2/5 Cancers

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About 40% of cancers could be prevented were people to stop smoking and overeating, limit alcohol intake, exercise regularly and get vaccines that target cancer-causing infections (e.g., HPV, Hepatitis B).  For more information on this, pleaase explore: the International Union Against Cancer's, "UICC Population Survey of Cancer-related Beliefs and Behaviours" (PDF), the World Cancer Campaign, “Today’s children, tomorrow’s world” or contact wcc@uicc.org directly. Exercise

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