Managing Managed Care

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

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About Managing Managed Care

A Testimonial


    Beautiful Site! Good Content.


                           Harvey S. Frey, MD, PhD, JD

    Harvey;  HARP Dialog on HMO Issues

  James Jerose (Principal, Nuvenu Business Advisors):
"Jeff, your tireless pursuit of quality, integrity, and value in health care delivery and systems over nearly four  decades is an inspiration to all of us who are your colleagues or who know you."

This website is entirely about doing the right thing at the right time and place in health care.

Health care reform is vital to our economy and our health as individuals and a nation.  The three main objectives in reform are: 1) contain costs, and 2) improve quality, while 3) maintaining timely and appropriate access. I often think of this as balancing a three-legged stool – difficult, but it can be done.

What we are not here to discuss, however, is "Managed Care,"* per se because right now, that is a horse of a different color–We are seeing it as new (but, it is not new). We read about it in legislation where it is now referred to as "Accountable" or "Affordable" care." Yesterday, however, the same effort may have been called a managed care organization (MCO), a health maintenance organization (HMO), an independent practice association (IPA), a Network (fat or thin), a preferred provider organization (PPO) or a Patient Centered Medical Home (PCMH)—The fact is, these are all merely variations on the theme of managed care, i.e., a semantical, not a substantive distinction.

Read on—we reveal when management is not improving the processes or outcomes of care. Moreover, we will tell you when proposed reform initiatives are real or the proponents (often self-serving) or politicians are merely playing a 'shell game' with your and our lives.

Our writers and editors are experienced managers of health care and very cognizant of the main reason why reform is not going well (despite the rhetoric)—it’s a matter of not knowing what works and shameful misalignment in incentives.

*  Managed Care is defined for these purposes as a system of health care management that is intended to reduce inappropriate and/or unnecessary health care expenditures.  Modus Operandi: Aligning patient and practitioner economic incentives so that all the key players–patients, practitioners and public–understand that there are usually options and that one should strive to select care that provides optimal value.+

Health Maintenance Organizations and Preferred Provider Organizations, for example, use various mechanisms to optimize value, but the key ones include measurement and management, continuity of care, follow-up, incentive alignment and caring.

+ Df. "Value," a relationship of perceived and objectively measured quality, cost-effectiveness and cost-benefit and appropriate access.

Please Note: is a Content Management System built on Drupal 7; it employs a unique rubric and taxonomy, which has been demonstrated to reduce some of the enormous complexity of health care.

  Jeffrey Gene Kaplan, MD, MS   (A 30-year veteran physician executive.)