Medicine's Cease-fire: Is It the Real Deal?


John Marcille

Paul Ellwood, M.D., who is generally recognized as the father of managed care as we know it, envisioned a world of health care delivery that featured HMOs with exclusive teams of physicians. The HMOs — and, indirectly, their physicians — would compete less on price than on quality of care and the ability to achieve superior outcomes.

We are a long way from Ellwood's vision of managed care. Not that Ellwood's is necessarily the best way that high-quality health care could be delivered. But the fallout from the mutation of his conception has has left a lot of plans, doctors and patients on the brink of revolt.

Or has it?

Look beyond the managed care backlash, and you'll see a quiet maturation taking place in the relationship between physicians and health plans. The two sides are getting together — sometimes out of necessity, sometimes out of genuine mutual desire. But at least they're acknowledging one another.

Our cover story — "Truce!" — examines this phenomenon. To be certain, battles will still be fought. But as physicians are beginning to accept managed care as the cornerstone of medical delivery in this country, payers are understanding that doctors are the core of the system. This is forcing an alignment of values. At the same time, an effort to link managed care companies with academic medical institutions — immersing tomorrow's physicians in the practices of managed care — is bearing fruit.

More signs of a truce: Health plans have a responsibility to use their data-mining capabilities to help physicians improve quality of care, and many are becoming sophisticated at doing that. As for physicians, before they can embrace managed care, they have to understand it. And more and more doctors are returning to the classroom to gain skills they need to participate in it. We cover both of these developments in this issue.

These occurrences are driven by a common goal: the provision of efficient, high-quality medical care.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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