Managing Managed Care

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

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Specialist Surfeit; Primary Care Paucity

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It's schadenfreude (enjoyment obtained from the troubles of others).  That's where I find myself as I observe the surfeit of specialists juxtaposed to a dearth of primary care docs. As Dr. Pauline W. Chen said in "Where Have All the Doctors Gone?"—"I [don’t] envy Mr. Obama.... Any attempt to make health care more accessible will be doomed to failure without an adequate number of primary care physicians and a strong primary care system."

The Nexus of Quality and Cost

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The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment.  Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments.  When it comes to lifestyle management, we fail, miserably.  For instance, getting people to stop smoking, the only thing that has worked is raising the pric

The 4 Main Reasons We Fail Reforming Health Care: Cost Fears, Variation, Poor Collaboration and Understanding

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Approximately 2/5 persons don't understand their insurance coverage, i.e., which healthcare services are being covered under their current plan and, 1 in 5, "have avoided visiting a doctor for a general health concern within the past 12 months because of cost concerns."

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:

When's "Good" Quality, Good Enough?

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"The current system is a mess because payment in the private sector is related to competition, contracts, etc. One gets paid a different amount by each. A single payer would have lower per episode payment, but would cover all and make billing simpler and more reliable." Leemore Dafny, PhD Harvard Business School Namita S.

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 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.   

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