Jeffrey Gene Kaplan, M.D., argues here that managed care is the best way to reform healthcare.
Among his remarks:
“Incentive alignment is critical. Capitation does not cut it simply because under it, the incentives are to do less. Also, capitation frustrates because a lot goes on that the provider cannot control. And, we all know the problems of fee for service, private practice, etc. It fractionalizes care and leads to unnecessary services and over-utilization. Separate primary from preventive care; reorganize care around patient medical or surgical conditions, forming what they call ‘Integrated Practice Units’ (essentially team work).”
He touts a 2013 by Porter and Lee that recommends:
1. Separating primary from preventive care and reorganizing care around patient medical or surgical conditions, forming what they call “Integrated Practice Units” (essentially team work).
2. “Measuring to manage the outcomes from the patient’s perspective and costs of the longitudinal view, the ‘cycle’ of care of every patient.”
3. Converting from fee-for-service or prospective payments to bundled payments for episodes of care.
4. Ensuring that healthcare-delivery systems be made collaborative.
5. Considering all care, not just local care.
6. Using information technology to integrate disparate elements of care and understand what happens to “whom,” “where” and “when,” and what works or does not, and communicate to improve efficiency and effectiveness.
