Managing Managed Care

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

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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 favorably affecting the medical loss ratio). 

The EHR—on the Road Where a Cottage Industry Lived

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Technology and automation are facilitating healthcare reform.  Meaningful communication is required at all levels and settings and that means interoperability is a must! 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.   

Real Reform...A Bird In the Hand Is Worth 2 In the Bush

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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);

Who's the Keeper of the Commons?

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Recognized as one of their “Top 9 Most Talked About Blogs of 2016,” see: “Who is ruining the healthcare system?” Medical Economics, 3/26/16. 

Cost is the Big Item in the Value Equation of Health Care and Here's Why

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The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., value, especially affordability.  To increase "value," one must raise quality, improve access and/or lower the cost of care. The latter, however, is an elusive goal; it is the elephant in the room.  The unrelenting rise in medical expenditures has nearly broken the back of so many consumers, "outstripping any growth in worker's wages" and net buying power.

Obsessive-Compulsive Disorder (OCD)

"Diagnosing and Treating OCD" by Katherine K. Dahlsgaard, PhD and Laurel Weaver, MD, PhD. [From The Children's Hospital of Philadelphia's Alumni Newsletter, republished here after being granted permission from Patrick S. Pasquariello, Jr, MD, Alumni Editor {jgk}]

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?

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?