Managing Managed Care

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

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Reform Issues

Waste Less; Add Value

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).  Read more Tags: waste, triple aim, value-based, over treatment, care coordination, outcomes, Population Health, risk adjustment, fraud and abuse, ​Coordinating, Communicating, comprehensive care Read more articles about: waste

The EHR—on the Road Where a Cottage Industry Lived

Technology and automation are facilitating healthcare reform.  Meaningful communication is required at all levels and settings and that means interoperability is a must! Read more Tags: interoperability, electronic health record, EHR, FHIR, EMR, episode, meaningful use, cost, quality, value, value-based care, feedback, communication, health information exchanges, HIE Read more articles about: communication/knowledge

Opportunity for Real Reform

We are now having an unprecedented opportunity for change, but Robert H. Brook, MD, ScD [The RAND Corporation] warns that simultaneously improving health care coverage, the affordability of health care and its quality is challenging.  Read more Tags: health care reform, fee-for-service, fee for service, payment reform, marketplace, coverage, health insurance, spending, benefit, FFS,, Luft, Brook, colonoscopy Read more articles about: Reform Issues

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

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]: Read more Tags: health care reform, health insurance, exchange, cooperative, Certification and Standards Criteria, meaningful use, Core Measures, public option, student, student health insurance, outcome, systems, information technology, bundled, episodes of care, longitudinal view, cost, quality, access Read more articles about: insurance and coverage issues

Who's the Keeper of the Commons?

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.  "This exploitation is analogous to what happens when incentives are not aligned in healthcare: payers, practitioners and patients at the commons are doing what they feel they must without accountability for equity in access, cost-effectiveness, benefit or cost-utility." A professor of biology gives us a... Read more Tags: home care, communication, top blog, The Tragedy of the Commons, outcome, keeper of the commons, bio-psycho-social, responsibility, equitable, health care system, genetics, vulnerability, adverse childhood experience, epigenetic, mental health Read more articles about: responsibility

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

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.  Read more Tags: quality, access, AI, artificial intelligence, engagement, cost-efficiency, spending, affordability, cost-effective, advocacy, outcomes, benefit, value, value equation, shell game Read more articles about: value

Doctoring All Of Health Care At Once

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.... Read more Tags: MACRA, Clinically Integrated Networks, MIPS, Care Information, ACI, Resource Use, Clinical Practice Improvement, CIN, ACO, aligned incentives, process, quality of care, accountable care organization, health care reform Read more articles about: Reform Issues

When's "Good" Quality, Good Enough?

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. Read more Tags: health status, engagement, AI, value-driven outcomes, potentially preventable events, PPE, information, quality, empathy, actionable, patient welfare, access, value, shell game, shared decision making, artificial intelligence Read more articles about: quality, cost and/or access

Enhancing HealthCare's Worth

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 Read more Tags: quality of care, home care, population analytics, outcomes, teaching, teach-back, silos, affordable, affordability, health literacy, analytics, transparency, acuity, incentive alignment, informatics Read more articles about: communication/knowledge


"Up to 30% of Medicare spending is wasted on needless care." Read more Tags: quality of care received by Medicare beneficiaries, quality of care, Wenberg, waste, lab, cost center, more effective care Read more articles about: waste