Managed Care


If Improvement Were Easy, It Would Have Happened Already

MANAGED CARE December 2011. © MediMedia USA
Editor's Memo

If Improvement Were Easy, It Would Have Happened Already

John Marcille
MANAGED CARE December 2011. ©MediMedia USA

John Marcille

We are not the first, and certainly won’t be the last, to point to clinical variation as a serious problem. To take one of many instances, the national health care expert David R. Nash, MD, and coauthor, Sanjaya Kumar, MD, call unexplained clinical variation the “core problem in American medicine” in their recent book Demand Better! Revive Our Broken Healthcare System. “[P]hysicians,” they write, “still rely heavily upon the ‘art’ of medicine: unsystematic personal clinical experience, clinical intuition, and judgments based on anecdotal evidence.”

Now an important player — the government — is acting. The Centers for Medicare & Medicaid Services will soon penalize hospitals for unnecessary readmissions. This happens as part of the Affordable Care Act and will coincide with the dissemination of data gained from comparative effectiveness research. If it is successful, expect health plans to work on ways to limit variation as well, as our cover story reports.

Will this end practice variation? There are never guarantees. Another story examines how difficult it is to execute bundled-payment contracts between payers and providers. The Rand study pointing this out was criticized by the overseers of the PROMETHEUS project, who say that progress has been made since the study data had been collected. Still, as the story mentions, if it were easy, it would have been done years ago.

Just ask Lee N. Newcomer, MD, MBA, UnitedHealthcare’s vice president for oncology. We did. My interview with him talks about the insurer’s pilot program testing a sort of bundled-payment model for oncologists. United and its five pilot sites have worked through many challenges.

Read about them.


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