Managed Care 101 in 2010-a Mini-Series (First set of blogs at MDNG.com)
Submitted by Dr. JG Kaplan on Sun, 2009-05-31 19:51
"Managed Care 101 in 2010" runs the gamut from how you measure and do something about value in health care, to cost-comparisons, to who you can and cannot trust, to the rights and obligations of patients and practitioners, and the purlicue--how to fight back.
"Managed Care 101 in 2010 (Part XIII-b): Sharing Perspectives - The Value Equation" – Originally published Tuesday, March 24, 2009
Karen Davis (Commonwealth Fund): "As you state -- in elegant mathematics" "I suggest we move toward a method of payment that emphasizes value."
5/30/10
Dr. Davis (Karen): you have been so helpful in the past helping me sort through the geopolitical issues about what is meant by "value" in healthcare. Now, I turn to the question of incentives in healthcare, a means to that end.
In "Health Reform's Impact: Health Spending to Shrink by $590 Billion, Family Premiums by $2,000, Over Next Decade," you folks wrote: "significant payment and system reform provisions in the Patient Protection and Affordable Care Act will begin to realign incentives within the health care system and reduce cost growth."
I am looking for specifics. In the ideal, organized healthcare system, how, exactly can or will incentives be realigned? And, you know from the balloon analogy; is there evidence that such efforts will have a net positive benefit and could such efforts be durable?
"Managed Care 101 in 2010 (Part XIII-c): Old 1994 Conversations Materializing into Current Topics" – Originally published Thursday, April 2, 2009
Here is an email discussion between a colleague and me about my value equation posted to a previous blog in this series (Part I-g).
"One Cannot Measure What One Does Not Manage": Cost-Comparing Treatments (Part XIII-d)" – Wednesday, April 8, 2009
When attempting to understand "value" in health care reform debate, comparative effectiveness and the cost of different medical treatments becomes a key issue.
Wednesday, April 15, 2009
Karen Davis, PhD, President of the Commonwealth Fund (see also Part XIII-b,) has been advocating that Medicare change its payment policy and move from volume-driven to value-driven healthcare. This is fundamental to health care reform.
"One Cannot Measure What One Does Not Manage": Wrong Bottom Line (Part XIII-f)" – Originally published Tuesday, April 21, 2009
The United States was observed to have spent 52% more per capita on health care than the next highest spending "economically competitor country with above-average per capita national income, and 90% more than many competitor countries."
"One Cannot Measure What One Does Not Manage": Lobbying with a Conflict of Interest (Part XIII-g)" – Originally published Friday, May 1, 2009
I have argued that the pharmaceutical industry has a legitimate role to play in healthcare and when they help practitioners achieve a better outcome for their patients, they should be garner a greater market share, price, and profit.
"One Cannot Measure What One Does Not Manage": If You Lie Down with Dogs, You Get Up with Fleas (Part XIII-h)" – Originally published Thursday, May 7, 2009
Specialist doctors go to the NY Attorney General to complain abotut a loss of revenue from less out of network referrals, steming from employers wanting to pay less for health insurance coverage and therefore restricting the network to reduce costs. But, they shoot theselves in the foot becuase the were forgiving legally required copays; they got cought. "Doctors want a government-run health plan will give more value for the dollar, and be more attuned to patient needs than a greedy private HMO! And that is PRECISELY why we should be in favor of it."
"One Cannot Measure What One Does Not Manage": The Regulators Are Not Your Friends (Part XIII-i)" – Originally published Thursday, May 14, 2009
"In 2000, the docs ran to NYS, recovery letters in hand, and demanded money for up-coded services billed to Oxford. Rather than getting Oxford spanked, they got NYS to investigate billing fraud, and the system worked against them. Not unlike the cop on the traffic patrol at the end of the month finding new opportunities to ticket, special investigation units were sic'd on them. It had a chilling effect on physician coding and cost them thousands."
"One Cannot Measure What One Does Not Manage: Shaking Down Docs (Part XIII-j)" – Originally published Tuesday, May 19, 2009
It should come as no surprise that Medicare managed care plans underpay out of network, i.e., non-participating physicians.
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