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A plug for managed care


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.

Where population health and consumerism meet


Health Forum convened a panel of healthcare executives and other experts on June 11 in New York City to discuss the intersection of population health and consumerism.

Here’s their discussion.


Key findings from the panel, as summarized by Hospitals & Health Networks:

• “As hospitals and health systems strive to become more consumer-friendly, they may need to rethink some common terminology, such as ‘patient-centered medical home’ and ‘discharge’ to reflect consumer sentiment.

• “Population-health management does not mean an organization needs to provide all things to all people. Instead, hospitals and health systems should focus their efforts on providing preventive care and wellness to certain populations, such as patients with co-morbidities.

• “Price and brand are top of mind for consumers. However, consumers are willing to go out of network for services if they find poor ratings among in-network physicians. Other important considerations for consumers are convenience and wait time.”

Feds close insurance loopholes


The U.S. Department of Health and Human Services has closed a series of insurance loopholes on coverage of preventive care.

The most important:

Henceforth insurers must cover at least one birth-control option under each of 18 methods approved by the Food and Drug Administration, and  without co-pays.

And insurers can’t charge patients for anesthesia  in connection with colonoscopies.

For insurers, the new government requirements take effect in 60 days but most consumers will not notice major changes until their coverage is renewed for 2016.

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